## 4 Discussion and Medico-Legal Implications  
The SARS-CoV-2 pandemic has imposed extraordinary efforts and restriction measures to flatten the virus spread curve. Since the human transmission of the COVID-19 occurs primarily through droplets, contacts, and fomites, social distancing measures were imposed in all countries [24]. In March 2020, in view of a health emergency, the Ministry of Health and the National Government recommended the public use the hospitals only in case of an absolute emergency [23]. Consequently, the Medical Office of several hospitals required the minimisation of elective surgical activity and deployed forces to cope with the exponential increase in infected and newly hospitalised patients. Both Sardinia and Calabria have adopted these measures [25; 26]. In this context, since the second week of March 2020, outpatient activities and non-urgent admissions at San Giovanni di Dio (University of Cagliari, Sardinia) and Mater Domini (University Magna Gracia of Catanzaro, Calabria) have been suspended [27; 28; 29; 30]. These measures remained in use until mid-June 2020. On 11 June 2020, after a drastic reduction in the number of infected people, the Italian First Minister signed the document governing the reopening of most activities, thus beginning the third phase of the emergency [31]. Concomitantly, elective surgical and outpatient activities at Sardinia and Calabria Hospitals have been restarted [32]. This phase remained in place until mid-September. The second wave of the pandemic coincided with the reopening of schools with new and significant outbreaks in Italy's largest cities [33]. New restrictions were imposed due to the resulting increase in infections, but this time, no longer nationally but regionally, based on the increase in infections and reduction in ICU beds. As a result, three phases were recognised in the first year of the COVID-19 pandemic. The first, from mid-March to mid-June, coincides with the National Lockdown; the second phase, the unlock phase, runs from the second half of June until the first half of September; lastly, the third and final phase known was the second wave until March 2021. We presently discussed the impact of the first year of the national and regional measures of virus spread containment in ophthalmology units of two of the major hospitals in southern Italy hospitals: San Giovanni di Dio in Sardinia and Mater Domini in Calabria. The main types of surgical procedures performed in the two hospitals were corneal surgery, vitreoretinal surgery, and cataract surgery. To the best of our knowledge, the present study is the first of its kind depicting the results of one year of measures of national containment on the ophthalmological surgical activity. During the lockdown, in both hospitals, a great reduction in surgical activity was observed, compared with the surgical activity during the equivalent period of the previous year. A reduction of 30% in all surgical services was observed in both ophthalmological units (Figure 1). With a closer examination regarding the subtype of surgery, it is evident that cataract surgery was more affected, with a drop of around 90% in both hospitals (Table 7). A similar trend has been described by [PERSON] et al. [34] in a cross-sectional, observational study that included patients who underwent cataract surgery, presenting between 23 March 2019 and 31 March 2021 to 4 tertiary and 20 secondary centres of a multi-tier ophthalmology network located in India. The authors found a drop of 92.5% in the number of cataract surgeries in the lockdown phase. This result was explained by both the containment measures imposed by the Indian government, as well as by the guidelines released by the All-India Ophthalmological Society (AIOS) [35]. Our findings suggest that the number of cataract surgical procedures recovered in the unlock phase, reaching its peak between July and August (Figure 3E,F).