## 4 Discussion and Medico-Legal Implications
For example, the frequency of urgent or emergent vitreoretinal procedures substantially decreased in the US during the lockdown ([PERSON] and [PERSON], 2017) and in India ([PERSON] and [PERSON], 2017). A similar scenario was observed at the SGD and UMG during the lockdown, but the trend reversed over the remaining 9 months (Figure 3C,D). The principal reason is that even in the worst months during the pandemic, the emergency eye-care centre of both clinics did not interrupt its service. As a result, patients affected by a retinal detachment, diabetic retinopathy, lens fragment in the vitreous chamber, or other emergencies were promptly referred for surgery (Table 5). Furthermore, the increase in the number of vitreoretinal surgeries during the second wave, more evident in Calabria, could be the consequence of the shut-down of local smaller hospitals and private clinics. In order to provide and preserve the continuity of care, various measures were adopted in accordance with the literature--first, the creation of the deferrable/non-deferrable patient list; second, a combined surgery including phacoemulsification; and finally, the choice of using endotamponade to reduce the follow-up visits and the risk of recurrence ([PERSON] and [PERSON], 2017; [PERSON], 2017). The results obtained showed a fluctuating trend regarding the number of patients treated during the period examined. With regard to the emergencies for which treatment could not be postponed, the numbers did not change with respect to the pre-pandemic period; however, the same cannot be affirmed with regard to elective surgery, with a clinical impact still not completely clear. Some authors have actually indicated that one of the 'collateral damages' of the pandemic is precisely the impact it has had, directly and indirectly, on the management of other morbid conditions ([PERSON] and [PERSON], 2017; [PERSON], 2017). Healthcare facilities have had to balance the need to ensure all care demands, on the one hand, and the need to minimise the risk of infection for patients and caregivers, on the other. Clearly, some ethical and medico-legal implications might arise from such issues ([PERSON] and [PERSON], 2017). In detail, there are two aspects that could represent a source of professional liability: On the one side, the postponement of therapeutic procedures could lead to an aggravation of the same pathology, with potential damage to the patient, and, on the other side, the risk that a patient could contract the virus during hospitalisation, which could be a cause of liability for nosocomial infection, especially in case of non-compliance with protocols and guidelines. In fact, although judicial data on med mal cases in the pandemic context are not yet available, a drastic increase in medical malpractice claims has been reported against individual professionals or, more generally, against healthcare facilities, in relation, for example, to organisational and inadequate medical assistance in non-COVID emergency diseases and the drastic increase in deaths in nursing homes for the elderly ([PERSON] and [PERSON], 2017). These events could also involve the ocular surgeon, also considering that, according to a recently published study referring to the pre-pandemic period, ophthalmology is, in Italy, the fourth most involved specialist branch in civil liability judgments, with a ratio of 50% between no. of cases and no. of convictions and an average paid compensation of approximately EUR 42.266,00 ([PERSON] and [PERSON], 2017). With reference to the more strictly regulatory aspects, Law no. 76 of 28.05.2021, containing urgent measures for the containment of the SARS-CoV-2 epidemic with regard to vaccinations against SARS-CoV-2, introduced the so-called 'criminal shield' in the Italian legal system for the crimes of manslaughter (Article 589 of the Criminal Code)and culpable personal injury (Article 590 of the Criminal Code) that have found their cause in the epidemiological emergency context.