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Sinha S, Kumar VB, Anand A, Sinha BP. Bilateral acute macular neuroretinopathy associated with COVID-19 infection presenting with central scotoma. Am J Ophthalmol Case Rep 2024; 35:102001. [PMID: 38827998 PMCID: PMC11141142 DOI: 10.1016/j.ajoc.2024.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/23/2023] [Accepted: 01/22/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose To report a case of bilateral acute macular neuroretinopathy (AMN) associated with COVID-19 infection presenting with central scotoma. Observation A 26-year-old female presented with a chief complaint of bilateral central scotomas for the last seven days. She had a history of fever over the past ten days, and RT-PCR test for COVID-19 was positive on the second day of fever. She had been vaccinated against COVID-19 eight months prior. Her best corrected visual acuity was 6/6 in both eyes on the Snellen chart. Dilated fundus evaluation revealed subtle bilateral perifoveal grey macular lesions. Optical coherence tomography (OCT) demonstrated focal hyperreflectivity at the level of the outer nuclear and plexiform layer consistent with bilateral AMN. Near-infrared reflectance (NIR) and red-free (RF) imaging showed large, confluent hyporeflective lesions in the right eye and discrete petaloid lesions with apices pointing toward the fovea in the left eye. OCT angiography (OCTA) revealed decreased flow signal at the level of the deep capillary plexus (DCP) and choriocapillaris (CC) in both eyes. Automated visual field testing (Humprey Field Analyzer (HFA) 24-2) revealed bilateral central scotoma with depression of adjacent points. After two weeks, the patient had depressed visual fields on HFA 10-2. At two months of final follow-up, OCT macula, NIR and RF images revealed resolving AMN lesions in both eyes. OCTA showed an increase in perfusion at the level of the DCP. There was a decrease in scotoma density on HFA 10-2, suggestive of resolving AMN. Conclusion and importance AMN with central scotoma as presenting feature of COVID-19 is rare. Fundus findings may be very subtle in AMN, but NIR and RF imaging delineate the lesions well. OCT, NIR imaging, OCTA and HFA 10-2 can be used to assess the clinical course of AMN.
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Affiliation(s)
- Shivani Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vidya Bhusan Kumar
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Abhishek Anand
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti Prassan Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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2
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Kal M, Brzdęk M, Karska-Basta I, Rzymski P, Pinna A, Zarębska-Michaluk D. Characteristics of the radial peripapillary capillary network in patients with COVID-19 based on optical coherence tomography angiography: A literature review. Adv Med Sci 2024; 69:312-319. [PMID: 38972386 DOI: 10.1016/j.advms.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/20/2024] [Accepted: 07/05/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE This review aimed to evaluate the significance of assessing radial peripheral capillary (RPC) network parameters by optical coherence tomography angiography (OCTA) in patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection confirmed by polymerase chain reaction. METHODS A literature search was conducted in the PubMed database to select high-quality reviews and original articles on the use of OCTA for visualizing the RPC network and calculating RPC parameters. RESULTS The study revealed that systemic hypoxia, hypercoagulable state, and inflammation affect the RPC network in patients with coronavirus disease 2019 (COVID-19). Reduced RPC parameters were observed early in the course of SARS-CoV-2 infection and after several months of follow-up. Additionally, there was a correlation between reduced RPC parameters and subsequent thinning of the retinal nerve fiber layer. CONCLUSIONS The OCTA examination of the retina and optic disc should be considered in patients with a history of COVID-19 to assess the impact of systemic hypoxia and inflammation on ocular function. Follow-up assessment of these patients is also necessary to understand the potential consequences of ischemia affecting the optic nerve, retina, and choroid.
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Affiliation(s)
- Magdalena Kal
- Collegium Medicum of Jan Kochanowski University in Kielce, Kielce, Poland; Ophthalmic Clinic of the Voivodeship Hospital in Kielce, Kielce, Poland
| | - Michał Brzdęk
- Collegium Medicum of Jan Kochanowski University in Kielce, Kielce, Poland.
| | - Izabella Karska-Basta
- Jagiellonian University Medical College, Faculty of Medicine, Department of Ophthalmology, Krakow, Poland; University Hospital, Clinic of Ophthalmology and Ocular Oncology, Krakow, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan' University of Medical Sciences, Poznan, Poland
| | - Antonio Pinna
- Department of Medicine, Surgery, and Pharmacy, Ophthalmology Unit, University of Sassari, Sassari, Italy
| | - Dorota Zarębska-Michaluk
- Collegium Medicum of Jan Kochanowski University in Kielce, Kielce, Poland; Department of Infectious Disease, Provincial Hospital in Kielce, Kielce, Poland
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3
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Ng HW, Scott DAR, Danesh-Meyer HV, Smith JR, McGhee CN, Niederer RL. Ocular manifestations of COVID-19. Prog Retin Eye Res 2024; 102:101285. [PMID: 38925508 DOI: 10.1016/j.preteyeres.2024.101285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
There is an increasing body of knowledge regarding how COVID-19 may be associated with ocular disease of varying severity and duration. This article discusses the literature on the ocular manifestations associated with COVID-19, including appraisal of the current evidence, suggested mechanisms of action, associated comorbidities and risk factors, timing from initial infection to diagnosis and clinical red flags. The current literature primarily comprises case reports and case series which inevitably lack control groups and evidence to support causality. However, these early data have prompted the development of larger population-based and laboratory studies that are emerging. As new data become available, a better appraisal of the true effects of COVID-19 on the eye will be possible. While the COVID-19 pandemic was officially declared no longer a "global health emergency" by the World Health Organization (WHO) in May 2023, case numbers continue to rise. Reinfection with different variants is predicted to lead to a growing cumulative burden of disease, particularly as more chronic, multi-organ sequelae become apparent with potentially significant ocular implications. COVID-19 ocular manifestations are postulated to be due to three main mechanisms: firstly, there is a dysregulated immune response to the initial infection linked to inflammatory eye disease; secondly, patients with COVID-19 have a greater tendency towards a hypercoagulable state, leading to prothrombotic events; thirdly, patients with severe COVID-19 requiring hospitalisation and are immunosuppressed due to administered corticosteroids or comorbidities such as diabetes mellitus are at an increased risk of secondary infections, including endophthalmitis and rhino-orbital-mucormycosis. Reported ophthalmic associations with COVID-19, therefore, include a range of conditions such as conjunctivitis, scleritis, uveitis, endogenous endophthalmitis, corneal graft rejection, retinal artery and vein occlusion, non-arteritic ischaemic optic neuropathy, glaucoma, neurological and orbital sequelae. With the need to consider telemedicine consultation in view of COVID-19's infectivity, understanding the range of ocular conditions that may present during or following infection is essential to ensure patients are appropriately triaged, with prompt in-person ocular examination for management of potentially sight-threatening and life-threatening diseases.
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Affiliation(s)
- Hannah W Ng
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Daniel A R Scott
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Charles Nj McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand.
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4
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An G, Lei B, Wang Z, Yang K, Fan D, Li B, Fu K, Fang H, Zhang M, Li L, Zhao Y, Jin X, Du L. Multicenter and multimodal imaging study reveals rare fundus lesions in patients after SARS-CoV-2 infection. Sci Rep 2024; 14:14369. [PMID: 38909148 PMCID: PMC11193808 DOI: 10.1038/s41598-024-65216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024] Open
Abstract
To define the characteristics of fundus manifestations in patients after SARS-CoV-2 infection with multimodal imaging techniques. This is a retrospective multicenter and multimodal imaging study including 90 patients. All patients with a visual complaint occurring immediately after SARS-CoV-2 infection were referred to six clinics between December 2022 and February 2023. Demographic information and the temporal relationship between SARS-CoV-2 infection and visual symptoms were documented. The characteristics of the fundus lesions were evaluated using multimodal imaging. Ninety patients from six hospitals were included in this study, including 24 males (26.67%) and 66 (73.33%) females. Seventy-eight patients (86.66%) (146 eyes) were diagnosed with Acute Macular Neuroretinopathy (AMN). The AMN patients were primarily young women (67.95%). Sixty-eight patients (87.18%) had AMN in both eyes. Thirty-eight eyes (24.36%) included Purtscher or Purtscher-like lesions. optical coherence tomography and infrared retinal photographs can show AMN lesions well. Eleven cases were diagnosed with simple Purtscher or Purtscher-like retinopathy (2 cases, 2.22%), Vogt‒Koyanagi‒Harada (VKH) syndrome or VKH-like uveitis (3 cases, 3.33%), multiple evanescent white-dot syndrome (MEWDS) (2 cases, 2.22%), and rhino-orbital-cerebral mucormycosis (ROCM) (5 cases, 5.56%). After SARS-CoV-2 infection, diversified fundus lesions were evident in patients with visual complaints. In this report, AMN was the dominant manifestation, followed by Purtscher or Purtscher-like retinopathy, MEWDS, VKH-like uveitis, and ROCM.
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Affiliation(s)
- Guangqi An
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China
| | - Bo Lei
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Eye institute, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
| | - Zhili Wang
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Kaizhuan Yang
- The Second People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Dongsheng Fan
- Department of Ophthalmology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Bing Li
- Nanyang Municipal Eye Hospital, Nanyang, Henan, China
| | - Ke Fu
- Department of Ophthalmology, The First Affiliated Hospital of Nanyang Medical College, Nanyang, Henan, China
| | - Haixin Fang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Min Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China
| | - Lin Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yu Zhao
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuemin Jin
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China.
| | - Liping Du
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China.
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Ting M, Hsueh J, Noori J. Multiple evanescent white dot syndrome associated with COVID-19 infection: a case report. J Med Case Rep 2024; 18:272. [PMID: 38849848 PMCID: PMC11161987 DOI: 10.1186/s13256-024-04596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/19/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND To report a case of Multiple Evanescent White Dot Syndrome (MEWDS) one month after a COVID-19 infection in a female patient at an age unusual for the occurrence of this disease. CASE PRESENTATION A 69-year-old Caucasian female reported the presence of floaters, photopsia, and enlarging vision loss in her left eye following the COVID-19 infection. Clinical and multimodal imaging was consistent with the MEWDS diagnosis. Fluorescein angiography examination revealed characteristic hyperfluorescent spots around the fovea in a wreath-like pattern. An extensive lab workup to rule out other autoimmune and infectious etiologies was inconclusive. Visual acuity and white dots resolved after a course of corticosteroids, which was confirmed on follow-up dilated fundus exam and multimodal imaging. CONCLUSIONS MEWDS is a rare white dot syndrome that may occur following COVID-19 infection in addition to other reported ophthalmic disorders following this infection.
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Affiliation(s)
- Michael Ting
- University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Jessica Hsueh
- University of Oklahoma College of Medicine, Oklahoma City, OK, USA
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L Young Blvd, Oklahoma City, OK, 73104, USA
| | - Jila Noori
- University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L Young Blvd, Oklahoma City, OK, 73104, USA.
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Song YY, Kim JT, Chang YS, Lee MW, Lee SC. Increased incidence and diverse manifestations of multiple evanescent white dot syndrome during the COVID-19 pandemic. Sci Rep 2024; 14:12425. [PMID: 38816508 PMCID: PMC11139874 DOI: 10.1038/s41598-024-63255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
The advent of coronavirus disease 2019 (COVID-19) pandemic has affected the incidence and course of various diseases and numerous studies have investigated ocular involvement associated with COVID-19 and corresponding vaccines. In this study, we compared the incidence of multiple evanescent white dot syndrome (MEWDS) before and during the COVID-19 pandemic at a single center in Korea and analyzed the demographic and clinical features of patients with MEWDS presenting during the COVID-19 pandemic. We categorized patients with MEWDS into two groups according to date of diagnosis. Pre-COVID19 group included patients diagnosed during the pre-pandemic period (between March 11, 2017, and March 10, 2020), whereas post-COVID19 group included patients diagnosed during the pandemic period (between March 11, 2020, and March 10, 2023). 6 and 12 patients were included in pre-COVID19 group and post-COVID19 group, respectively. Among all hospital visits during the pre-pandemic and pandemic periods, 0.011% and 0.030% were due to MEWDS, indicating a significant increase during the pandemic (p = 0.029, B = 2.756). The annual incidence of patients with MEWDS in 2017-2022 were 0.73, 0.75, 0.78, 1.32, 2.49, and 2.07 per 10,000 population, respectively, corresponding to a significant increase (p = 0.039, B = 1.316). Our results imply that the incidence and manifestation of MEWDS are likely to become more diverse in the COVID-19 pandemic era.
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Affiliation(s)
- Yong Yeon Song
- Onnuri Eye Hospital, #325 Baekje-daero, Jeonju, Republic of Korea.
| | - Jung Tae Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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Stawowski AR, Konopińska J, Stawowski SS, Adamczuk J, Groth M, Moniuszko-Malinowska A, Czupryna P. The Review of Ophthalmic Symptoms in COVID-19. Clin Ophthalmol 2024; 18:1417-1432. [PMID: 38803556 PMCID: PMC11129748 DOI: 10.2147/opth.s460224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
The COVID-19 pandemic caused by SARS-CoV-2 had a significant impact on the health of the global human population, affecting almost every human organ, including the organ of vision. Research focus on understanding the pathophysiology, identifying symptoms and complications of the disease. Eye-related pathologies are important foci of research due to the potential for direct impact of the virus. Ophthalmologists around the world are reporting various symptoms of eye infections and ocular pathologies associated with SARS-CoV-2. The review of ophthalmic symptoms was conducted to help physicians of various specialties recognize possible ophthalmic manifestations of this viral disease. A literature review was conducted from January 2020 to July 2023 in the PubMed, MEDLINE, Science Direct, Scopus, Scielo and Google Scholar databases. The review of the literature showed that conjunctivitis is the most common ophthalmic symptom observed during the course of COVID-19 and can occur at any stage of the disease. Changes in the eye may result from the direct effect of the virus, immune response, prothrombotic states, comorbidities, and medications used. Symptoms related to the organ of vision can be divided into: changes affecting the protective apparatus of the eye, the anterior eye segment, the posterior eye segment, neuro-ophthalmic, and orbital changes. Ocular symptoms may suggest COVID-19 infection or appear several weeks after recovery. Following COVID-19 vaccinations, a diverse range of ophthalmic symptoms was observed in various locations and at different times, mirroring the ocular symptoms experienced throughout the course of the COVID-19 illness. It is important for physicians of all specialties to be aware of possible potential connections between eye diseases and SARS-CoV-2, in order to effectively diagnose and treat patients.
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Affiliation(s)
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | | | - Justyna Adamczuk
- Department of Infectious Diseases and Neuroinfectious, Medical University of Bialystok, Bialystok, Poland
| | - Monika Groth
- Department of Allergology and Internal Diseases, University Clinical Hospital in Bialystok, Bialystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfectious, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfectious, Medical University of Bialystok, Bialystok, Poland
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Zhang C, Cheng S, Chen H, Yang J, Chen Y. New findings on retinal microvascular changes in patients with primary COVID-19 infection: a longitudinal study. Front Immunol 2024; 15:1404785. [PMID: 38835770 PMCID: PMC11148381 DOI: 10.3389/fimmu.2024.1404785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose To investigate the longitudinal alterations of retinal microvasculature in patients with primary coronavirus disease 2019 (COVID-19) infection. Methods A cohort of participants, who had never been infected with COVID-19, was recruited between December 2022 and May 2023 at Peking Union Medical College Hospital in Beijing, China. Participants underwent comprehensive ophthalmologic examinations and fundus imaging, which included color fundus photography, autofluorescence photography, swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography (SS-OCTA). If participants were infected with COVID-19 during the study, follow-ups with consistent imaging modality were conducted within one week and two months after recovery from the infection. Results 31 patients (61 eyes), with a mean age of 31.0 ± 7.2 years old, were eligible for this study. All participants contracted mild COVID-19 infection within one month of baseline data collection. The average period was 10.9 ± 2.0 days post-infection for the first follow-up and 61.0 ± 3.5 days for the second follow-up. No clinical retinal microvasculopathy features were observed during the follow-ups. However, SS-OCTA analysis showed a significant increase in macular vessel density (MVD) from 60.76 ± 2.88% at baseline to 61.59 ± 3.72%(p=0.015) at the first follow-up, which subsequently returned to the baseline level of 60.23 ± 3.33% (p=0.162) at the two-month follow-up. The foveal avascular zone (FAZ) remained stable during the follow-ups with areas of 0.339 ± 0.097mm2, 0.342 ± 0.093mm2, and 0.344 ± 0.098mm2 at the baseline, first follow-up (p=0.09) and second follow-up (p=0.052), respectively. Central macular thickness, cube volume and ganglion cell-inner plexiform layer showed a transient decrease at the first follow-up(p<0.001, p=0.039, p=0.002, respectively), and increased to baseline level at the two-month follow-up(p=0.401, p=0.368, p=0.438, respectively). Conclusion Mild COVID-19 infection may temporarily and reversibly impact retinal microvasculature, characterized by a transient increase in retinal blood flow during the early recovery phase, which returns to the pre-infection level two months post-infection.
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Affiliation(s)
- Chenxi Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shiyu Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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9
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Chirapapaisan N, Eiamsamarng A, Chuenkongkaew W, Rattanathamsakul N, Ratanarat R. The prone position in COVID-19 impacts the thickness of peripapillary retinal nerve fiber layers and macular ganglion cell layers. PLoS One 2024; 19:e0300621. [PMID: 38696393 PMCID: PMC11065264 DOI: 10.1371/journal.pone.0300621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/03/2024] [Indexed: 05/04/2024] Open
Abstract
The prone position reduces mortality in severe cases of COVID-19 with acute respiratory distress syndrome. However, visual loss and changes to the peripapillary retinal nerve fiber layer (p-RNFL) and the macular ganglion cell layer and inner plexiform layer (m-GCIPL) have occurred in patients undergoing surgery in the prone position. Moreover, COVID-19-related eye problems have been reported. This study compared the p-RNFL and m-GCIPL thicknesses of COVID-19 patients who were placed in the prone position with patients who were not. This prospective longitudinal and case-control study investigated 15 COVID-19 patients placed in the prone position (the "Prone Group"), 23 COVID-19 patients not in the prone position (the "Non-Prone Group"), and 23 healthy, non-COVID individuals without ocular disease or systemic conditions (the "Control Group"). The p-RNFL and m-GCIPL thicknesses of the COVID-19 patients were measured at 1, 3, and 6 months and compared within and between groups. The result showed that the Prone and Non-Prone Groups had no significant differences in their p-RNFL thicknesses at the 3 follow-ups. However, the m-GCIPL analysis revealed significant differences in the inferior sector of the Non-Prone Group between months 1 and 3 (mean difference, 0.74 μm; P = 0.009). The p-RNFL analysis showed a significantly greater thickness at 6 months for the superior sector of the Non-Prone Group (131.61 ± 12.08 μm) than for the Prone Group (118.87 ± 18.21 μm; P = 0.039). The m-GCIPL analysis revealed that the inferior sector was significantly thinner in the Non-Prone Group than in the Control Group (at 1 month 80.57 ± 4.60 versus 83.87 ± 5.43 μm; P = 0.031 and at 6 months 80.48 ± 3.96 versus 83.87 ± 5.43 μm; P = 0.044). In conclusion, the prone position in COVID-19 patients can lead to early loss of p-RNFL thickness due to rising intraocular pressure, which is independent of the timing of prone positioning. Consequently, there is no increase in COVID-19 patients' morbidity burden.
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Affiliation(s)
- Niphon Chirapapaisan
- Faculty of Medicine Siriraj Hospital, Department of Ophthalmology, Mahidol University, Bangkok, Thailand
| | - Akarawit Eiamsamarng
- Faculty of Medicine Siriraj Hospital, Department of Ophthalmology, Mahidol University, Bangkok, Thailand
| | - Wanicha Chuenkongkaew
- Faculty of Medicine Siriraj Hospital, Department of Ophthalmology, Mahidol University, Bangkok, Thailand
| | - Natthapon Rattanathamsakul
- Faculty of Medicine Siriraj Hospital, Department of Medicine, Division of Neurology, Mahidol University, Bangkok, Thailand
| | - Ranistha Ratanarat
- Faculty of Medicine Siriraj Hospital, Department of Medicine, Division of Critical Care, Mahidol University, Bangkok, Thailand
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10
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Pai V, Bileck A, Hommer N, Janku P, Lindner T, Kauer V, Rumpf B, Haslacher H, Hagn G, Meier-Menches SM, Schmetterer L, Schmidl D, Gerner C, Garhöfer G. Impaired retinal oxygen metabolism and perfusion are accompanied by plasma protein and lipid alterations in recovered COVID-19 patients. Sci Rep 2024; 14:8395. [PMID: 38600099 PMCID: PMC11006918 DOI: 10.1038/s41598-024-56834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
The aim of the present study was to investigate retinal microcirculatory and functional metabolic changes in patients after they had recovered from a moderate to severe acute COVID-19 infection. Retinal perfusion was quantified using laser speckle flowgraphy. Oxygen saturation and retinal calibers were assessed with a dynamic vessel analyzer. Arterio-venous ratio (AVR) was calculated based on retinal vessel diameter data. Blood plasma samples underwent mass spectrometry-based multi-omics profiling, including proteomics, metabolomics and eicosadomics. A total of 40 subjects were included in the present study, of which 29 had recovered from moderate to severe COVID-19 within 2 to 23 weeks before inclusion and 11 had never had COVID-19, as confirmed by antibody testing. Perfusion in retinal vessels was significantly lower in patients (60.6 ± 16.0 a.u.) than in control subjects (76.2 ± 12.1 a.u., p = 0.006). Arterio-venous (AV) difference in oxygen saturation and AVR was significantly lower in patients compared to healthy controls (p = 0.021 for AVR and p = 0.023 for AV difference in oxygen saturation). Molecular profiles demonstrated down-regulation of cell adhesion molecules, NOTCH3 and fatty acids, and suggested a bisphasic dysregulation of nitric oxide synthesis after COVID-19 infection. The results of this study imply that retinal perfusion and oxygen metabolism is still significantly altered in patients well beyond the acute phase of COVID-19. This is also reflected in the molecular profiling analysis of blood plasma, indicating a down-regulation of nitric oxide-related endothelial and immunological cell functions.Trial Registration: ClinicalTrials.gov ( https://clinicaltrials.gov ) NCT05650905.
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Affiliation(s)
- Viktoria Pai
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria
| | - Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Patrick Janku
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Theresa Lindner
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Victoria Kauer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Medicine IV for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Benedikt Rumpf
- Department of Medicine IV for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hagn
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
| | - Samuel M Meier-Menches
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria.
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria.
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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11
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Monu M, Ahmad F, Olson RM, Balendiran V, Singh PK. SARS-CoV-2 infects cells lining the blood-retinal barrier and induces a hyperinflammatory immune response in the retina via systemic exposure. PLoS Pathog 2024; 20:e1012156. [PMID: 38598560 PMCID: PMC11034659 DOI: 10.1371/journal.ppat.1012156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/22/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
SARS-CoV-2 has been shown to cause wide-ranging ocular abnormalities and vision impairment in COVID-19 patients. However, there is limited understanding of SARS-CoV-2 in ocular transmission, tropism, and associated pathologies. The presence of viral RNA in corneal/conjunctival tissue and tears, along with the evidence of viral entry receptors on the ocular surface, has led to speculation that the eye may serve as a potential route of SARS-CoV-2 transmission. Here, we investigated the interaction of SARS-CoV-2 with cells lining the blood-retinal barrier (BRB) and the role of the eye in its transmission and tropism. The results from our study suggest that SARS-CoV-2 ocular exposure does not cause lung infection and moribund illness in K18-hACE2 mice despite the extended presence of viral remnants in various ocular tissues. In contrast, intranasal exposure not only resulted in SARS-CoV-2 spike (S) protein presence in different ocular tissues but also induces a hyperinflammatory immune response in the retina. Additionally, the long-term exposure to viral S-protein caused microaneurysm, retinal pigmented epithelium (RPE) mottling, retinal atrophy, and vein occlusion in mouse eyes. Notably, cells lining the BRB, the outer barrier, RPE, and the inner barrier, retinal vascular endothelium, were highly permissive to SARS-CoV-2 replication. Unexpectedly, primary human corneal epithelial cells were comparatively resistant to SARS-CoV-2 infection. The cells lining the BRB showed induced expression of viral entry receptors and increased susceptibility towards SARS-CoV-2-induced cell death. Furthermore, hyperglycemic conditions enhanced the viral entry receptor expression, infectivity, and susceptibility of SARS-CoV-2-induced cell death in the BRB cells, confirming the reported heightened pathological manifestations in comorbid populations. Collectively, our study provides the first evidence of SARS-CoV-2 ocular tropism via cells lining the BRB and that the virus can infect the retina via systemic permeation and induce retinal inflammation.
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Affiliation(s)
- Monu Monu
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Rachel M. Olson
- Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri, United States of America
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, United States of America
| | - Vaishnavi Balendiran
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, United States of America
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12
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Westwood J, Mayhook-Walker I, Simpkins C, Darby-Smith A, Morris D, Normando E. Retinal Vascular Changes in Response to Hypoxia: A High-Altitude Expedition Study. High Alt Med Biol 2024; 25:49-59. [PMID: 38011631 DOI: 10.1089/ham.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Westwood, Jessica, India Mayhook-Walker, Ciaran Simpkins, Andrew Darby-Smith, Dan Morris, and Eduardo Normando. Retinal vascular changes in response to hypoxia: a high-altitude expedition study. High Alt Med Biol. 25:49-59, 2024. Background: Increased tortuosity and engorgement of retinal vasculature are recognized physiological responses to hypoxia. This can lead to high-altitude retinopathy (HAR), but incidence reports are highly variable, and our understanding of the etiological mechanisms remains incomplete. This study quantitatively evaluated retinal vascular changes during an expedition to 4,167 m. Methods: Ten healthy participants summited Mount Toubkal, Morocco. Fundus images were taken predeparture, daily throughout the expedition, and 1 month postreturn. Diameter and tortuosity of four vessels were assessed, in addition to vessel density and features of HAR. Results: Significant (p ≤ 0.05) increases in tortuosity and diameter were observed in several vessels on high-altitude exposure days. There was a strong correlation between altitude and supratemporal retinal artery diameter on days 2, 3, and 6 of the expedition (r = 0.7707, 0.7951, 0.7401, respectively; p < 0.05). There was a significant increase in median vessel density from 6.7% at baseline to 10.0% on summit day. Notably there were no incidences of HAR. Conclusion: Physiological but not pathological changes were seen in this cohort, which gives insight into the state of the cerebral vasculature throughout this expedition. These results are likely attributable to relatively low altitude exposure, a conservative ascent profile, and the cohort's demographic. Future study must include daily retinal images at higher altitudes and take steps to mitigate environmental confounders. This study is relevant to altitude tourists, patients with diabetic retinopathy or retinal vein occlusion, and critically ill patients.
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Affiliation(s)
- Jessica Westwood
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
| | - India Mayhook-Walker
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
| | - Ciaran Simpkins
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
| | - Andrew Darby-Smith
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Dan Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Eduardo Normando
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
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13
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Duan X, Huang Z, Zhang S, Zhu G, Wang R, Wang Z. SARS-CoV-2 Infection Impairs Oculomotor Functions: A Longitudinal Eye-tracking Study. J Eye Mov Res 2024; 17:10.16910/jemr.17.1.2. [PMID: 38694262 PMCID: PMC11060831 DOI: 10.16910/jemr.17.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Although Severe Acute Respiratory Syndrome Coronavirus 2 infection (SARS-CoV-2) is primarily recognized as a respiratory disease, mounting evidence suggests that it may lead to neurological and cognitive impairments. The current study used three eye-tracking tasks (free-viewing, fixation, and smooth pursuit) to assess the oculomotor functions of mild infected cases over six months with symptomatic SARS-CoV-2 infected volunteers. Fifty symptomatic SARS-CoV-2 infected, and 24 self-reported healthy controls completed the eye-tracking tasks in an initial assessment. Then, 45, and 40 symptomatic SARS-CoV-2 infected completed the tasks at 2- and 6-months post-infection, respectively. In the initial assessment, symptomatic SARS-CoV-2 infected exhibited impairments in diverse eye movement metrics. Over the six months following infection, the infected reported overall improvement in health condition, except for self-perceived mental health. The eye movement patterns in the free-viewing task shifted toward a more focal processing mode and there was no significant improvement in fixation stability among the infected. A linear discriminant analysis shows that eye movement metrics could differentiate the infected from healthy controls with an accuracy of approximately 62%, even 6 months post-infection. These findings suggest that symptomatic SARSCoV- 2 infection may result in persistent impairments in oculomotor functions, and the employment of eye-tracking technology can offer valuable insights into both the immediate and long-term effects of SARS-CoV-2 infections. Future studies should employ a more balanced research design and leverage advanced machine-learning methods to comprehensively investigate the impact of SARSCoV- 2 infection on oculomotor functions.
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Affiliation(s)
| | | | | | | | - Rong Wang
- Zhejiang Sci-Tech University, Hangzhou, China
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14
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Cunha Filho AADA, Pugliese Neto PM, Pereira GH, de Lima Filho NG, Sakakisbara LA, Estofolete CF, Nogueira ML, de Mattos LC, Brandão CC. Portable color retinography findings in COVID-19 patients admitted to the ward. Photodiagnosis Photodyn Ther 2024; 45:103965. [PMID: 38218571 DOI: 10.1016/j.pdpdt.2024.103965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
Retinal lesions, including cotton-wool exudates, microbleeds, vascular occlusions and vasculitis, occur in a minority of Coronavirus Disease-19 (COVID-19) patients. Retinal assessments using retinography can help document these lesions. The objective of this work was to identify retinal changes in patients admitted to the ward with a positive Real Time Quantitative Polymerase Chain Reaction (RT-qPCR) exam for COVID-19. A cross-sectional, observational study was carried out of patients with mild and moderate symptoms admitted to the Hospital de Base in São José do Rio Preto. The Eyer® portable retinal camera (Phelcom® Technologies) was used to evaluate 30 male and 21 female patients. The ages ranged from 21 to 83 years (mean: 47 years). Systemic arterial hypertension was identified in 21 (41.2 %) and diabetes mellitus in 12 (23.5 %) patients. Six (11.7 %) reported worsening visual acuity, however, none of these patients had ocular findings to justify this complaint. Ten patients (19.6 %) had intraretinal hemorrhages; one (1.9 %) had cotton-wool exudates and seven (13.7 %) had dilations of veins. Thirteen patients (25.4 %) had vascular tortuosity and six (11.7 %) had pathological arteriovenous crossings. Portable retinography is useful to evaluate patients admitted to isolation wards due to COVID-19. It is important to remember that some of the patients investigated had comorbidities like diabetic maculopathy and systemic arterial hypertension. Hence, some care should be taken in attributing these observations uniquely to COVID-19 infection.
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Affiliation(s)
- Antônio Augusto de Andrade Cunha Filho
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil; Hospital de Base Regional Medical School Foundation (HB-FUNFARME), São José do Rio Preto, SP, Brazil
| | - Perseu Matheus Pugliese Neto
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil; Hospital de Base Regional Medical School Foundation (HB-FUNFARME), São José do Rio Preto, SP, Brazil
| | - Gabriela Hamra Pereira
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil; Hospital de Base Regional Medical School Foundation (HB-FUNFARME), São José do Rio Preto, SP, Brazil
| | - Neuder Gouveia de Lima Filho
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil; Hospital de Base Regional Medical School Foundation (HB-FUNFARME), São José do Rio Preto, SP, Brazil
| | - Luis Antonio Sakakisbara
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil; Hospital de Base Regional Medical School Foundation (HB-FUNFARME), São José do Rio Preto, SP, Brazil
| | - Cássia Fernanda Estofolete
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil; Hospital de Base Regional Medical School Foundation (HB-FUNFARME), São José do Rio Preto, SP, Brazil.
| | | | - Luiz Carlos de Mattos
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
| | - Cinara Cássia Brandão
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
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15
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Curran EH, Devine MD, Hartley CD, Huang Y, Conrady CD, Debiec MR, Justin GA, Thomas J, Yeh S. Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework. Front Med (Lausanne) 2024; 10:1349571. [PMID: 38293299 PMCID: PMC10824978 DOI: 10.3389/fmed.2023.1349571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
As technology continues to evolve, the possibility for a wide range of dangers to people, organizations, and countries escalate globally. The United States federal government classifies types of threats with the capability of inflicting mass casualties and societal disruption as Chemical, Biological, Radiological, Nuclear, and Energetics/Explosives (CBRNE). Such incidents encompass accidental and intentional events ranging from weapons of mass destruction and bioterrorism to fires or spills involving hazardous or radiologic material. All of these have the capacity to inflict death or severe physical, neurological, and/or sensorial disabilities if injuries are not diagnosed and treated in a timely manner. Ophthalmic injury can provide important insight into understanding and treating patients impacted by CBRNE agents; however, improper ophthalmic management can result in suboptimal patient outcomes. This review specifically addresses the biological agents the Center for Disease Control and Prevention (CDC) deems to have the greatest capacity for bioterrorism. CBRNE biological agents, encompassing pathogens and organic toxins, are further subdivided into categories A, B, and C according to their national security threat level. In our compendium of these biological agents, we address their respective CDC category, systemic and ophthalmic manifestations, route of transmission and personal protective equipment considerations as well as pertinent vaccination and treatment guidelines.
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Affiliation(s)
- Emma H. Curran
- Creighton University School of Medicine, Omaha, NE, United States
| | - Max D. Devine
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Caleb D. Hartley
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ye Huang
- Department of Ophthalmology, University of Illinois-Chicago, Chicago, IL, United States
| | - Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew R. Debiec
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Grant A. Justin
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Joanne Thomas
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
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16
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Gronbeck C, Grzybowski A, Grant-Kels JM. COVID-19 and the eye. Clin Dermatol 2024; 42:17-24. [PMID: 37865278 DOI: 10.1016/j.clindermatol.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
There is growing literature describing the ocular manifestations of COVID-19. We have assessed published reviews, cross-sectional analyses, and clinical reports to summarize the ocular manifestations of the disease and available vaccines, identify the potential role of ocular transmission, and offer basic clinical guidance to health care providers. Ultimately, self-limiting conjunctivitis and conjunctival hyperemia are the most frequently reported ocular findings; several rarer entities may warrant targeted topical therapies. COVID-19 vaccines have been infrequently associated with the development of rare but significant side effects that may warrant ophthalmologist referral as well as specific treatments. Despite the overall low risk of ocular transmission, eye protection is advisable for health care providers in high-risk scenarios. This review should help to guide the assessment of patients with eye complaints in the setting of COVID-19 to promote appropriate diagnosis, treatment, monitoring, and referral.
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Affiliation(s)
- Christian Gronbeck
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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17
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Ahmad F, Deshmukh N, Webel A, Johnson S, Suleiman A, Mohan RR, Fraunfelder F, Singh PK. Viral infections and pathogenesis of glaucoma: a comprehensive review. Clin Microbiol Rev 2023; 36:e0005723. [PMID: 37966199 PMCID: PMC10870729 DOI: 10.1128/cmr.00057-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, caused by the gradual degeneration of retinal ganglion cells and their axons. While glaucoma is primarily considered a genetic and age-related disease, some inflammatory conditions, such as uveitis and viral-induced anterior segment inflammation, cause secondary or uveitic glaucoma. Viruses are predominant ocular pathogens and can impose both acute and chronic pathological insults to the human eye. Many viruses, including herpes simplex virus, varicella-zoster virus, cytomegalovirus, rubella virus, dengue virus, chikungunya virus, Ebola virus, and, more recently, Zika virus (ZIKV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have been associated with sequela of either primary or secondary glaucoma. Epidemiological and clinical studies suggest the association between these viruses and subsequent glaucoma development. Despite this, the ocular manifestation and sequela of viral infections are not well understood. In fact, the association of viruses with glaucoma is considered relatively uncommon in part due to underreporting and/or lack of long-term follow-up studies. In recent years, literature on the pathological spectrum of emerging viral infections, such as ZIKV and SARS-CoV-2, has strengthened this proposition and renewed research activity in this area. Clinical studies from endemic regions as well as laboratory and preclinical investigations demonstrate a strong link between an infectious trigger and development of glaucomatous pathology. In this article, we review the current understanding of the field with a particular focus on viruses and their association with the pathogenesis of glaucoma.
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Affiliation(s)
- Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nikhil Deshmukh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aaron Webel
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandra Johnson
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ayman Suleiman
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Rajiv R. Mohan
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Frederick Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
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18
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Tang J, Li S, Wang Z, Tao Y, Zhang L, Yin H, Miao H, Sun Y, Qu J. Acute Macular Neuroretinopathy after SARS-CoV-2 Infection: An Analysis of Clinical and Multimodal Imaging Characteristics. Diagnostics (Basel) 2023; 13:3600. [PMID: 38132184 PMCID: PMC10742651 DOI: 10.3390/diagnostics13243600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study aimed to analyze clinical and multimodal imaging characteristics of acute macular neuroretinopathy (AMN) post-recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS Retrospective observational study. Medical records and multimodal imaging of 12 AMN eyes of eight patients (six female and two male) with recent SARS-CoV-2 infection were retrospectively analyzed. RESULTS Four patients (50%) presented with bilateral AMN. Fundus ophthalmoscopy revealed a reddish-brown lesion around the macula, and two eyes had cotton-wool spots at the posterior pole. Three eyes showed mild hypo-autofluorescence. All FFA images (7 eyes) showed no abnormal signs. On OCT scans, all eyes showed outer nuclear layer (ONL) thinning, 8 eyes (66.7%) showed ONL hyperreflectivity, 5 eyes (41.7%) showed outer plexiform layer (OPL) hyperreflectivity, 8 eyes (66.7%) showed interdigitation zone (IZ) disruption, 11 eyes (91.6%) showed ellipsoid zone (EZ) disruption, 2 eyes (16.7%) showed cotton-wool spots and inner plexiform layer (IPL) hyperreflectivity, 1 eye (8.3%) had intraretinal cyst and 1 eye (8.3%) had inner nuclear layer (INL) thinning. Persistent scotoma, ONL hyperreflectivity and IZ/EZ disruption as well as recovery of OPL hyperreflectivity were reported after follow-up in three cases. CONCLUSIONS AMN post-SARS-CoV-2 mostly affected young females and could present unilaterally or bilaterally. Dark lesions on IR reflectance and outer retinal hyperreflectivity on OCT are useful in diagnosing AMN. OPL/ONL hyperreflectivity on OCT could disappear after follow-up, but ONL thinning and IZ/EZ could persist.
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Affiliation(s)
- Jiyang Tang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Siying Li
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Zongyi Wang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Ye Tao
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Linqi Zhang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Hong Yin
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Heng Miao
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Yaoyao Sun
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Jinfeng Qu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing 100044, China
- Eye Diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
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19
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Kutlutürk Karagöz I, Önder Tokuç E, Karabaş L, Rückert R, Kaya M, Munk MR. Expression of key SARS-CoV-2 entry molecules in surgically obtained human retinal biopsies. Int Ophthalmol 2023; 43:5055-5062. [PMID: 37847479 DOI: 10.1007/s10792-023-02908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To investigate the presence of ACE2, TMPRSS2 and Furin, i.e., a key player in the ocular infection with SARS-COV-2, in surgically obtained human retinal tissue samples from SARS-CoV-2-negative patients, using gene expression analysis. METHODS The mechanisms and entry paths of ocular infections have been ill-defined so far. To better understand the possible entry routes, we used surgically explanted retinal tissue from nine patients that were not infected with SARS-CoV-2 and analyzed the message expression of the three key molecules that confer viral entry into cells using polymerase chain reaction. RESULTS The median age of the patients (n = 9) included in the study was 52 years (IQR 48, 55). Eight patients underwent surgery for rhegmatogenous retinal detachment and one patient for tractional retinal detachment. Gene expression for the proteins studied was detected in all nine patients. The results of analysis by Livak's method (2001) demonstrated a median TMPRSS2 gene expression value of 20.9 (IQR 11.7, 33.7), a median ACE2 gene expression value of 2.09 (IQR 1.14, 2.79) and a median Furin gene expression value of 8.33 (IQR 5.90, 11.8). CONCLUSION In conclusion, TMPRSS2, Furin and ACE2 are expressed in the retina and may contribute to the retinal involvement in COVID-19 patients. Expression may vary among individuals, which may explain why some patients may be more prone to retinal involvement during SARS-CoV-2 infection COVID-19 patients than others. Variability in the expression of TMPRSS2, Furin and ACE2 proteins themselves may also explain the presence or development of retinal symptoms of varying severity.
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Affiliation(s)
| | - Ecem Önder Tokuç
- Ophthalmology Department, Kocaeli University School of Medicine, Izmit, Kocaeli, Turkey
| | - Levent Karabaş
- Ophthalmology Department, Kocaeli University School of Medicine, Izmit, Kocaeli, Turkey.
| | | | | | - Marion R Munk
- Inselspital, University Hospital Bern, Bern, Switzerland
- BPRC, Bern Photographic Reading Center, University of Bern, Bern, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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20
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Kalavar M, El Khatib B, Suelves AM, Yanoga F. Purtscher-like retinopathy in patients with COVID-19. Am J Ophthalmol Case Rep 2023; 32:101915. [PMID: 37663997 PMCID: PMC10474068 DOI: 10.1016/j.ajoc.2023.101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose Several ophthalmological complications of coronavirus disease 2019 (COVID-19) involving the anterior and posterior segment have been reported in the literature. We present two patients with Purtscher-like retinopathy presenting with bilateral central vision loss and diffuse peripapillary cotton wool spots extending into the macula bilaterally. Observations In both cases, the patients were diagnosed with COVID-19 within a week of their presentations and had relatively mild courses of COVID-19. In the first case, the patient's vision was hand motion in the right eye and count fingers in the left eye. A broad workup was negative, revealing no concerns for underlying conditions traditionally associated with Purtscher-like retinopathy. Head and neck imaging was also negative for vascular abnormalities. The patient was given a diagnosis of Purtscher-like retinopathy due to COVID-19 infection and was started on 60 mg of oral prednisone. At 4-week follow up, patient's vision had improved to 20/100 in the right eye and 20/80 in the left eye, although she continued to have minimal central vision. The patient continued to have Purtscher flecken in the posterior pole, but the density of the opacities and retinal hemorrhages had significantly improved. In the second case, the patient's past medical history was significant for Huntington's disease and kidney transplant on dialysis but she had not had any ocular issues prior. One week within diagnosis of COVID-19, she presented with a vision of count fingers in the right eye and 20/400 in the left eye. The patient's baseline dose of 5 mg prednisone was increased to 60 mg for 1 week. She received an Ozurdex implant in both eyes. The patient's vision at 9 week follow up improved to 20/40 pinholing to 20/25 in the right eye and 20/200 pinholing to 20/70 in the left eye and dilated exam showed improving edema and improving density of Purtscher-flecken from initial presentation. Conclusions and importance Very few cases of COVID-19 associated Purtscher-like retinopathy have been reported in the literature and all have been reported with serious clinical courses of COVID-19. To the best of our knowledge, these are the first cases to be reported after relatively mild courses of COVID-19 and highlight the importance of including COVID-19 in the differential for Purtscher-like retinopathy.
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Affiliation(s)
- Meghana Kalavar
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bahaeddin El Khatib
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ana M. Suelves
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Fatoumata Yanoga
- Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
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21
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Gluckstein JA, Chwalisz BK, Gilbert AL, Bouffard MA. SARS-CoV-2 Parainfectious Optic Neuropathy: 3 Case Reports and a Review of the Literature. J Neuroophthalmol 2023; 43:491-498. [PMID: 37974364 DOI: 10.1097/wno.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Parainfectious optic neuritis is an inflammatory reaction that occurs shortly after an infection without direct invasion by a pathogen. The clinical profile depends on the infectious organism. Cases of SARS-CoV-2 parainfectious optic neuritis have been reported in the literature, but there are no reviews that have applied strict inclusion criteria to more definitively establish the clinical profile associated with SARS-CoV-2. METHODS We present 3 new cases of SARS-CoV-2 parainfectious optic neuritis. We also review the literature for definite cases by selecting only those with unambiguous clinical features and MRI findings of optic neuritis, positive SARS-CoV-2 polymerase chain reaction or serology, and the absence of myelin oligodendrocyte-glycoprotein or aquaporin-4 antibodies or other diseases associated with optic neuritis. RESULTS We report 2 cases of monophasic, unilateral SARS-CoV-2 parainfectious optic neuritis with optic disc edema and nadir visual acuities of finger counting. We report 1 case of mild SARS-CoV-2 parainfectious optic neuritis that featured cotton wool spots, peripapillary wrinkles and hemorrhages, and recurrence after an initial steroid taper. We identified 6 cases of unambiguous SARS-CoV-2 parainfectious optic neuritis from the literature. Combining our case series with the case reports in the literature, the average age was 42.8 years, 3/9 had bilateral disease, 6/8 had optic disc edema, 8/9 had nadir visual acuity of finger counting or worse, and all recovered visual acuity to 20/40 or better after therapy with steroids. CONCLUSIONS SARS-CoV-2 parainfectious optic neuritis has a clinical profile that is atypical for idiopathic optic neuritis but fairly typical of parainfectious forms of optic neuritis with a severely reduced nadir visual acuity, high likelihood of bilaterality, high incidence of optic disc edema, and prompt and significant response to corticosteroids. Further study with long-term follow-up and epidemiologic investigation will be needed to further characterize this clinical entity.
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Affiliation(s)
- Jeffrey A Gluckstein
- Neuro-ophthalmology (JAG, BKC, MAB), Massachusetts Eye and Ear, Boston, Massachusetts; Neurology (BKC), Massachusetts General Hospital, Boston, Massachusetts; Ophthalmology and Neuro-Ophthalmology (ALG), Kaiser Permanente Vallejo Medical Center, Vallejo, California; and Neuro-Ophthalmology (MAB), Beth Israel Deaconess Medical Center, Boston, Massachusetts
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22
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Sen HN, Vannella KM, Wang Y, Chung JY, Kodati S, Ramelli SC, Lee JW, Perez P, Stein SR, Grazioli A, Dickey JM, Ylaya K, Singh M, Yinda KC, Platt A, Ramos-Benitez MJ, Zerbe C, Munster VJ, de Wit E, Warner BM, Herr DL, Rabin J, Saharia KK, Kleiner DE, Hewitt SM, Chan CC, Chertow DS. Histopathology and SARS-CoV-2 Cellular Localization in Eye Tissues of COVID-19 Autopsies. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1809-1816. [PMID: 36963628 PMCID: PMC10032059 DOI: 10.1016/j.ajpath.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 03/24/2023]
Abstract
Ophthalmic manifestations and tissue tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in association with coronavirus disease 2019 (COVID-19), but the pathology and cellular localization of SARS-CoV-2 are not well characterized. The objective of this study was to evaluate macroscopic and microscopic changes and investigate cellular localization of SARS-CoV-2 across ocular tissues at autopsy. Ocular tissues were obtained from 25 patients with COVID-19 at autopsy. SARS-CoV-2 nucleocapsid gene RNA was previously quantified by droplet digital PCR from one eye. Herein, contralateral eyes from 21 patients were fixed in formalin and subject to histopathologic examination. Sections of the droplet digital PCR-positive eyes from four other patients were evaluated by in situ hybridization to determine the cellular localization of SARS-CoV-2 spike gene RNA. Histopathologic abnormalities, including cytoid bodies, vascular changes, and retinal edema, with minimal or no inflammation in ocular tissues were observed in all 21 cases evaluated. In situ hybridization localized SARS-CoV-2 RNA to neuronal cells of the retinal inner and outer layers, ganglion cells, corneal epithelia, scleral fibroblasts, and oligodendrocytes of the optic nerve. In conclusion, a range of common histopathologic alterations were identified within ocular tissue, and SARS-CoV-2 RNA was localized to multiple cell types. Further studies will be required to determine whether the alterations observed were caused by SARS-CoV-2 infection, the host immune response, and/or preexisting comorbidities.
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Affiliation(s)
- H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Kevin M Vannella
- the Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Yujuan Wang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Joon-Yong Chung
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Sabrina C Ramelli
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jung Wha Lee
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Paola Perez
- Salivary Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Sydney R Stein
- the Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alison Grazioli
- Department of Medicine, R Adams Crowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - James M Dickey
- the Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kris Ylaya
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Manmeet Singh
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Kwe Claude Yinda
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Andrew Platt
- the Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marcos J Ramos-Benitez
- the Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Postdoctoral Research Associate Training Program, National Institute of General Medical Sciences, National Institutes of Health, Bethesda, Maryland
| | - Christa Zerbe
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Vincent J Munster
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Emmie de Wit
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Blake M Warner
- Salivary Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Daniel L Herr
- Department of Medicine, R Adams Crowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joseph Rabin
- Department of Surgery and Program in Trauma, R Adams Crowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kapil K Saharia
- Department of Medicine, Division of Infectious Disease, University of Maryland School of Medicine, Baltimore, Maryland
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Chi-Chao Chan
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel S Chertow
- the Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
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23
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Gao Y, Zhang Y, Mou K, Liu Y, Chen Q, Man S, Xu H, Zhou J, Wang T, Li Y, Chen Y, Zhang M. Assessment of alterations in the retina and vitreous in pre- and post-COVID-19 patients using swept-source optical coherence tomography and angiography: A comparative study. J Med Virol 2023; 95:e29168. [PMID: 37815403 DOI: 10.1002/jmv.29168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/06/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023]
Abstract
Ocular manifestations have been well recognized in coronavirus disease 2019 (COVID-19) outbreak. Several studies have detected ocular manifestations in patients after COVID-19. However, little is known about the retinal and vitreal alterations in patients before and after COVID-19 infection. This study aimed to investigate the retinal and vitreal alterations in patients before and after contracting COVID-19 infection using swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA). A total of 38 participants (76 eyes) were enrolled and followed-up 1 month after COVID-19 infection. Then, 26 patients (52 eyes) were evaluated 3 months after COVID-19 infection. Compared with the pre-COVID-19 status, patients with 1- and 3-month post-COVID-19 statuses had significant thinning of ganglion cell and inner plexiform layer, thickening of inner nuclear layer, a decrease in the vessel density (VD) of superficial vascular complex, and an increase in the VD of deep vascular complex. Meanwhile, alteration in parameters of foveal avascular zone (all p < 0.05) and hyper-reflective dots in the vitreous of 27 patients (54 eyes) (71.1% vs. pre-COVID-19, 34.2%, p = 0.006) were observed. These findings suggest significantly retinal and vitreal alterations occurred in patients after COVID-19 infection, possibly due to direct or indirect virus-induced injuries. Further longitudinal studies are required to investigate the long-term effects of COVID-19 infection on the human eyes.
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Affiliation(s)
- Yuzhu Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology and Research Laboratory of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yifan Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Kefan Mou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yilin Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qing Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Shulei Man
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hanyue Xu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jiaming Zhou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ting Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yating Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yi Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
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24
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Pellegrini M, Carnevali A, Fiore T, Cagini C, De Palma A, Fontana L, Lupardi E, Cassini F, Bacherini D, Giansanti F, Giannaccare G, Scorcia V, Vaccaro S, Ciarmatori N, D'Angelo S, Parmeggiani F, Mura M. Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series. Eye (Lond) 2023; 37:3000-3003. [PMID: 36813998 PMCID: PMC9945824 DOI: 10.1038/s41433-023-02459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/20/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND To evaluate the association between COVID-19 vaccination and retinal vein occlusion (RVO). METHODS This multicentre self-controlled case series included patients with RVO seen in five tertiary referral centres in Italy. All adults who received at least one dose of the BNT162b2, ChAdOx1 nCoV-19, mRNA-1273 or Ad26.COV2.S vaccine and had a first diagnosis of RVO between January 01, 2021, and December 31, 2021 were included. Incidence rate ratios (IRRs) of RVO were estimated using Poisson regression, comparing rates of events in a 28-day period following each dose of vaccination and in the unexposed control periods. RESULTS 210 patients were included in the study. No increased risk of RVO was observed after the first dose (1-14 days IRR: 0.87, 95% CI: 0.41-1.85; 15-28 days IRR: 1.01, 95% CI: 0.50-2.04; 1-28 days IRR: 0.94, 95% CI: 0.55-1.58) and second dose of vaccination (1-14 days IRR: 1.21, 95% CI: 0.62-2.37; 15-28 days IRR: 1.08, 95% CI: 0.53-2.20; 1-28 days IRR: 1.16, 95% CI: 0.70-1.90). No association between RVO and vaccination was found in subgroup analyses by type of vaccine, gender and age. CONCLUSIONS This self-controlled case series found no evidence of an association between RVO and COVID-19 vaccination.
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Affiliation(s)
- Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
- Department of Ophthalmology, Ospedali Privati Forlì "Villa Igea", Forlì, Italy.
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.
| | - Adriano Carnevali
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Tito Fiore
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonella De Palma
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Lupardi
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Cassini
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Daniela Bacherini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Sabrina Vaccaro
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Nicolò Ciarmatori
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Sergio D'Angelo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Marco Mura
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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25
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Ślizień M, Sulecka P, Tylicki L, Janicka Z, Konopa J, Ślizień Z, Dębska-Ślizień A, Michalska-Małecka K, Biedunkiewicz B. Comprehensive Assessment of Eyes in Kidney Transplant Recipients after Recovering from COVID-19. Life (Basel) 2023; 13:2003. [PMID: 37895384 PMCID: PMC10608157 DOI: 10.3390/life13102003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Patients after organ transplantation with COVID-19 have a higher risk of morbidity and mortality than patients in the general population. There are single studies that assess the eyes of COVID-19 patients, but there are no such studies on organ transplant recipients. The purpose of this study was to comprehensively examine the eyes of kidney transplant recipients (KTR) after recovery from mild to moderate SARS-CoV-2 infection. METHODS A total of 40 KTR after COVID-19 and 20 KTR without clinical and immunological symptoms of SARS-CoV-2 infection as a control group was qualified for the cross-sectional study. A total of 76 eyes from 38 KTR on an average of 7 weeks after COVID-19 and 36 eyes from 18 KTR from the control group were studied. The participants underwent an ophthalmological examination, and the retinal and choroid vessels and nerves were assessed by optical coherence tomography angiography. RESULTS We found a lower vessel density (VD) in the deep capillary plexus in the central part of the retina (VD deep central) of the study group. Women had significantly lower VD deep central in the study group (15.51 vs. 18.91, p < 0.001). Multivariate linear regression analysis confirmed an independent, negative impact of COVID-19 (p < 0.001) and female gender (p = 0.001) on VD deep central. CONCLUSION The results of our study confirmed that changes in microcirculation induced by SARS-CoV-2 infection may affect the retinal vessels in KTR. Mild to moderate COVID-19 in KTR resulted in a significant reduction in VD deep central of the retina, with these changes being more common in females.
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Affiliation(s)
- Mateusz Ślizień
- Ophthalmology Clinic, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.Ś.); (P.S.); (Z.J.); (K.M.-M.)
| | - Paulina Sulecka
- Ophthalmology Clinic, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.Ś.); (P.S.); (Z.J.); (K.M.-M.)
| | - Leszek Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (L.T.); (J.K.); (Z.Ś.); (A.D.-Ś.)
| | - Zofia Janicka
- Ophthalmology Clinic, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.Ś.); (P.S.); (Z.J.); (K.M.-M.)
| | - Joanna Konopa
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (L.T.); (J.K.); (Z.Ś.); (A.D.-Ś.)
| | - Zuzanna Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (L.T.); (J.K.); (Z.Ś.); (A.D.-Ś.)
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (L.T.); (J.K.); (Z.Ś.); (A.D.-Ś.)
| | - Katarzyna Michalska-Małecka
- Ophthalmology Clinic, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.Ś.); (P.S.); (Z.J.); (K.M.-M.)
| | - Bogdan Biedunkiewicz
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-952 Gdańsk, Poland; (L.T.); (J.K.); (Z.Ś.); (A.D.-Ś.)
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Carletti P, Shah A, Bair C, Curran C, Mai A, Patel R, Moorthy R, Villate N, Davis JL, Vitale AT, Shakoor A, Hassman L. The spectrum of COVID-19-associated chorioretinal vasculopathy. Am J Ophthalmol Case Rep 2023; 31:101857. [PMID: 37255549 PMCID: PMC10193817 DOI: 10.1016/j.ajoc.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose Although conjunctivitis represents the most common ocular manifestation of COVID-19 infection, sight-threatening retinal involvement has been reported. Herein, we report and characterize with multimodal retinal imaging 5 cases of acute vision loss secondary to presumed chorioretinal vasculopathy temporally associated with COVID-19 infection with varying severity, visual morbidity, and treatment response, and review the available literature on the association between COVID-19 infection and retinal microvascular changes. Design Observational case series and literature review. Methods Multicenter case series of 5 patients who presented to academic centers and private offices with acute vision loss temporally associated with COVID-19 infection. A review of the literature was conducted using online databases. Results 10 eyes of 5 patients, 3 men and 2 women, with a mean age of 30.8 years (median 33, range 16-44) were described. All patients had a recently preceding episode of COVID-19, with symptomatology ranging from mild infection to life-threatening encephalopathy. Treatment for their retinal disease included topical, oral, intravitreal, and intravenous steroids, steroid-sparing immunosuppression, retinal photocoagulation, antivirals, and antiplatelet and anticoagulant agents. Treatment response and visual recovery ranged from complete recovery of baseline acuity to permanent vision loss and need for chronic immunosuppression. Conclusions and Importance Clinicians should be mindful of the potential for vision-threatening retinal involvement after COVID-19 infection. If found, treatment with both anti-inflammatory therapy and anticoagulation should be considered, in addition to close monitoring, as some patients with this spectrum of disease may require chronic immune suppression and/or anti-VEGF therapy.
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Affiliation(s)
- Piero Carletti
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aaditya Shah
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher Bair
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | | | - Anthony Mai
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Rachel Patel
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Ramana Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Indianapolis, IN, USA
| | - Natalia Villate
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Fort Lauderdale Eye Institute, Fort Lauderdale, FL, USA
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Albert T Vitale
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Akbar Shakoor
- John A. Moran Eye Center, University of Utah Health, Salt Lake City, UT, United States
| | - Lynn Hassman
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Araujo-Silva CA, Marinho PM, Marcos AAA, Branco AMC, Sakamoto V, Matuoka ML, Moraes NF, Tierno PFGMM, Mourad WM, Nascimento H, Burnier M, de Souza W, Belfort R. Postmortem Ultrastructural Analysis of the Retina from COVID-19 Deceased Patients. Ocul Immunol Inflamm 2023:1-9. [PMID: 37552861 DOI: 10.1080/09273948.2023.2238817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE COVID-19 (coronavirus disease 2019) is an infectious disease caused by SARS-CoV-2, first reported in 2019 in Wuhan, China. Among the common complications is a pro-inflammatory and hypercoagulative response that compromises the vasculature among various organs. METHODS In this report, we present the postmortem retinal findings of five patients observed by means of optical microscopy and transmission and scanning electron microscopy techniques. RESULTS Clinical manifestations such as retinal hemorrhages and exacerbated inflammatory infiltrate, altered ultra structure with swollen mitochondria and pyknotic cells in both layers of the retina were observed in all analyzed eyes. CONCLUSION Our data point to the fragility of this tissue in cases of severe COVID-19.
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Affiliation(s)
- Carlla A Araujo-Silva
- Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens - INBEB, Rio de Janeiro, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagens - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Mateus L Matuoka
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | - Nara F Moraes
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | | | - Walid M Mourad
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Heloisa Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | - Miguel Burnier
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens - INBEB, Rio de Janeiro, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagens - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
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Shrivastav A, Zhou WS, Ng S, Ding J, Gilada T, Chua CH, Dutt S, Natarajan S, Agrawal R. Choroidal Microvascular Alterations in COVID-19 Patients. Ocul Immunol Inflamm 2023; 31:1122-1127. [PMID: 35413220 DOI: 10.1080/09273948.2022.2062387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/10/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate alterations in the choroidal angioarchitecture of COVID-19 patients using optical Coherence Tomography (OCT) based surrogate markers. METHODS This prospective case-control study recruited 56 COVID-19 patients (111 eyes) and 61 healthy individuals (120 eyes). Choroidal thickness (CT) and Choroidal vascularity index (CVI) were derived from OCT images using a purpose-built automated software for choroidal image segmentation. A linear mixed model with age and gender as covariates was employed to compare CVI and CT between groups. RESULTS COVID-19 patients had significantly higher subfoveal (81.3um vs 86.8um, p = .02), temporal (78.8um vs 84.3um, p = .005), nasal (87.5um vs 95.1um, p = .001) and average CT (82.5um vs 88.7um, p = .001). COVID-19 patients had significantly lower subfoveal (64.0 vs 63.5, p = .02) and average CVI (63.5 vs 63.1, p = .02). CONCLUSION COVID-19 results in significantly thicker choroid with reduced relative vascularity. This may be attributable to increased vascular permeability secondary to inflammation, resulting in choroidal stromal edema.
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Affiliation(s)
| | - Wenting Sandy Zhou
- Khoo Teck Puat Hospital, Ophthalmology &Visual Science, National Health Group Eye Institute, Singapore
| | - Sean Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jianbin Ding
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Department of General Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore
| | - Trupti Gilada
- Infectious Disease, Masina Hospital, Mumbai, India
- Infectious Diseases, Unison Medicare and Research Centre, Mumbai, India
| | - Chun Hau Chua
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Shibjash Dutt
- Research and development, Radical Health, New Delhi, India
| | | | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Korva-Gurung I, Kubin AM, Ohtonen P, Hautala N. Visual Outcomes of Anti-VEGF Treatment on Neovascular Age-Related Macular Degeneration: A Real-World Population-Based Cohort Study. Pharmaceuticals (Basel) 2023; 16:927. [PMID: 37513839 PMCID: PMC10384898 DOI: 10.3390/ph16070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
Neovascular age-related macular degeneration (nAMD) leads to visual impairment if not treated promptly. Intravitreal anti-VEGF drugs have revolutionized nAMD treatment in the past two decades. We evaluated the visual outcomes of anti-VEGF treatment in nAMD. A real-life population-based cohort study. The data included parameters for age, sex, age at diagnosis, laterality, chronicity, symptoms, visual outcomes, lens status, and history of intravitreal injections. A total of 1088 eyes (827 patients) with nAMD were included. Visual acuity was stable or improved in 984 eyes (90%) after an average of 36 ± 25 months of follow-up. Bevacizumab was the first-line drug in 1083 (99.5%) eyes. Vision improved ≥15 ETDRS letters in 377 (35%), >5 ETDRS letters in 309 (28%), and was stable (±5 ETDRS letters) in 298 (27%) eyes after anti-VEGF treatment. The loss of 5 ≤ 15 ETDRS letters in 44 (4%) eyes and ≥15 ETDRS letters in 60 (6%) eyes was noted. At the diagnosis of nAMD, 110 out of 827 patients (13%) fulfilled the criteria for visual impairment, whereas 179 patients (22%) were visually impaired after the follow-up. Improvement or stabilization in vision was noted in 90% of the anti-VEGF-treated eyes with nAMD. In addition, anti-VEGF agents are crucial in diminishing nAMD-related visual impairment.
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Affiliation(s)
- Ida Korva-Gurung
- Research Unit of Clinical Medicine and Medical Research Center, Department of Ophthalmology, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland
| | - Anna-Maria Kubin
- Research Unit of Clinical Medicine and Medical Research Center, Department of Ophthalmology, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland
- Medical Research Center, PEDEGO Research Unit, Department of Ophthalmology, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland
| | - Pasi Ohtonen
- Research Service Unit, 90220 Oulu, Finland
- The Research Unit of Surgery, Anesthesia and Intensive Care, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland
| | - Nina Hautala
- Research Unit of Clinical Medicine and Medical Research Center, Department of Ophthalmology, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland
- Medical Research Center, PEDEGO Research Unit, Department of Ophthalmology, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland
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30
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Kal M, Płatkowska-Adamska B, Zarębska-Michaluk D, Rzymski P. Reduced Vessel Density and Enlarged Foveal Avascular Zone in the Macula as a Result of Systemic Hypoxia Caused by SARS-CoV-2 Infection. J Pers Med 2023; 13:926. [PMID: 37373915 DOI: 10.3390/jpm13060926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Infection with SARS-CoV-2 can lead to various long-term consequences, including those of an ophthalmic nature. This paper reviews the results of optical coherence tomography angiography (OCTA) performed among COVID-19 patients. The review included papers evaluating short- and long-term outcomes following the SARS-CoV-2 infection. Some differentiated the obtained retinal and choroidal vascularization parameters according to gender. Following COVID-19, patients reveal changes in retinal and choroidal vascular parameters based on OCTA, such as reduced vascular density and an increased foveal avascular zone, which can persist for several months. Routine ophthalmic follow-up with OCTA should be considered in patients after SARS-CoV-2 infection to assess the effects of inflammation and systemic hypoxia in COVID-19. Further research is needed to understand whether infection with particular viral variants/subvariants may vary in the risk of effects on retinal and choroidal vascularization and whether and to what extent these risks may also differ in relation to reinfected and vaccinated individuals.
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Affiliation(s)
- Magdalena Kal
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- Ophthalmic Clinic, Voivodeship Hospital, 25-736 Kielce, Poland
| | | | - Dorota Zarębska-Michaluk
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- Department of Infectious Disease, Provincial Hospital, 25-317 Kielce, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznań University of Medical Sciences, 60-806 Poznan, Poland
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31
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Monera Lucas CE, Baeza Diaz MV, Quesada JA, Lopez-Pineda A, Fernandez Martinez C, Martinez Toldos JJ, Gil-Guillén VF. Tomographic Findings in the Retina of Unvaccinated Patients with COVID Pneumonia: Prospective Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095659. [PMID: 37174177 PMCID: PMC10178088 DOI: 10.3390/ijerph20095659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
There is no definitive evidence on the extent of SARS-CoV-2's effect on the retina. This study aims to determine if the natural history of SARS-CoV-2 infection affects tomographic findings in the retina of patients with COVID-19 pneumonia. This is a prospective cohort study of patients hospitalized with COVID-19 pneumonia. The patients underwent ophthalmological explorations and optical coherence tomography during the acute phase of the infection and at a follow-up 12 weeks later. The primary outcomes were the central retinal thickness and central choroidal thickness, which were compared longitudinally and with non-COVID-19 historical controls. No statistically relevant differences were observed in the longitudinal analysis of the thickness of the central retina (p = 0.056), central choroid (p = 0.99), retinal nerve fiber layer (p = 0.21), or ganglion cell layer (p = 0.32). Patients with acute COVID-19 pneumonia showed significantly greater central retinal thickness than non-COVID controls (p = 0.006). In conclusion, tomographic measures of the retina and choroid are not influenced by the phase of COVID-19 infection and remain stable during 12 weeks. The central retinal thickness may increase in the acute phase of COVID-19 pneumonia, but more epidemiological studies using optical coherence tomography in the early stages of the disease are needed.
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Affiliation(s)
- Carlos Enrique Monera Lucas
- Retina Unit, Ophthalmology Service, General University Hospital of Elche, 03203 Elche, Spain
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Manuel Vicente Baeza Diaz
- Retina Unit, Ophthalmology Service, General University Hospital of Elche, 03203 Elche, Spain
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Jose A Quesada
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 03550 Alicante, Spain
| | - Adriana Lopez-Pineda
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 03550 Alicante, Spain
| | | | - Jose Juan Martinez Toldos
- Retina Unit, Ophthalmology Service, General University Hospital of Elche, 03203 Elche, Spain
- Department of Pathology and Surgery, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Vicente F Gil-Guillén
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 03550 Alicante, Spain
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Nassisi M, Pozzo Giuffrida F, Milella P, Ganci S, Aretti A, Mainetti C, Dell'Arti L, Mapelli C, Viola F. Delaying anti-VEGF therapy during the COVID-19 pandemic: long-term impact on visual outcomes in patients with neovascular age-related macular degeneration. BMC Ophthalmol 2023; 23:156. [PMID: 37069537 PMCID: PMC10107548 DOI: 10.1186/s12886-023-02864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/17/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES To evaluate the outcomes of delayed intravitreal injections (IVIs) caused by the outbreak of coronavirus disease 2019 (COVID-19), in patients with neovascular age-related macular degeneration (nAMD). METHODS nAMD patients with scheduled IVIs between March 1st and April 30th, 2020 were stratified through a risk-based selection into a non-adherent group (NA-group) if they skipped at least one IVI and an adherent group (A-group) if they followed their treatment schedule. During the pandemic visit (v0), if a significant worsening of the disease was detected, a rescue therapy of three-monthly IVIs was performed. Multimodal imaging and best-corrected visual acuity (BCVA) findings were evaluated after 6 months (v6), compared between groups and with the visit prior the lockdown (v-1). RESULTS Two hundred fifteen patients (132 females, mean age: 81.89 ± 5.98 years) delayed their scheduled IVI while 83 (53 females, mean age: 77.92 ± 6.06 years) adhered to their protocol. For both groups, BCVA at v0 was significantly worse than v-1 (mean 4.15 ± 7.24 ETDRS letters reduction for the NA-group and 3 ± 7.96 for the A-group) but remained stable at v6. The two groups did not significantly differ in BCVA trends after 6 months and neither for development of atrophy nor fibrosis. CONCLUSIONS A risk-based selection strategy and a rescue therapy may limit the long-term outcomes of an interruption of the treatment protocol in patients with nAMD.
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Affiliation(s)
- Marco Nassisi
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Francesco Pozzo Giuffrida
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Paolo Milella
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Simone Ganci
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Aretti
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Claudia Mainetti
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Dell'Arti
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Mapelli
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy.
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Soysal GG, Kimyon S, Mete A, Güngör K. Evaluation of the retina with optical coherence tomography angiography (OCTA) in patients with coronavirus (COVID-19) infection. J Fr Ophtalmol 2023:S0181-5512(23)00228-0. [PMID: 37088627 PMCID: PMC10106811 DOI: 10.1016/j.jfo.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The goal of this study is to compare the optical coherence tomography angiography (OCTA) findings in Coronavirus (COVID-19) positive adult and pediatric patients with those of healthy volunteers with the same demographic characteristics. METHODS The right eye of 157 adults infected with covid, 168 healthy adult volunteers, 40 children (6-18 years of age) infected with covid, and 44 healthy children (6-18 years of age) were included in this prospective study. All participants underwent ophthalmological examination and OCTA. The OCTA findings were evaluated. RESULTS Deep nasal density (DND), deep inferior density (DID), and deep parafoveal density (DPD) were significantly lower in the pediatric covid-affected group (PCAG) than in the pediatric healthy control group (PHCG) (P=0.034, P=0.029, P=0.022 respectively). On the other hand, radial peripapillary capillary vessel density (RPCVD) intra-disc measurements were significantly higher in the PCAG compared to the PHCG (P=0.025). There was no significant difference between the OCTA measurements of the adult covid-affected group (ACAG) and the adult healthy control group (AHCG). CONCLUSION In our study, significant differences were found in OCTA measurements between the covid group and the healthy control group in children. Retinal microvascular changes may occur in patients with covid infection, and these patients might be followed for long-term retinal changes.
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Affiliation(s)
- G G Soysal
- Ersin-Arslan Education and Research Hospital Ophthalmology Department, 27000 Gaziantep, Turkey.
| | - S Kimyon
- Gaziantep University Hospital Ophthalmology Department, Gaziantep, Turkey
| | - A Mete
- Gaziantep University Hospital Ophthalmology Department, Gaziantep, Turkey
| | - K Güngör
- Gaziantep University Hospital Ophthalmology Department, Gaziantep, Turkey
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Evaluation of Retinal Vascularity Index in Patients with COVID-19: A Case-Control Study. Ophthalmol Ther 2023; 12:879-894. [PMID: 36547863 PMCID: PMC9774073 DOI: 10.1007/s40123-022-00630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the impact of COVID-19 infection on retinal microvasculature by topographically mapping the retinal arteriole-to-venule ratio (AVR). METHODS In a comparative cross-sectional case-control study, fundus photos were obtained in COVID-19-infected patients and healthy controls. AVT was measured over 16 points across the retina using retinal vascularity index (RVI)-a novel semi-automated computerized parameter based on retinal vasculature. RESULTS A total of 51 COVID-19-positive patients and 65 healthy controls were enrolled in the study. Overall, the mean RVI of all 16 points across the retina was 0.34 ± 0.02 in patients with COVID-19 and 0.33 ± 0.02 in control subjects (p = 0.64). Out of the 16 points being measured, three points had a statistically significant greater value in patients with COVID compared to normal controls. CONCLUSION Localised greater RVI values were found in some of the points in COVID-19-positive patients, which likely indicates a more focal change of the vasculature.
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Bajka A, Muth DR, Wiest MRJ, Said S, Rejdak M, Sidhu S, Foa N, Blaser F, Barthelmes D, Toro MD, Souied EH, Deuel JW, Schlagenhauf P, Zweifel SA. Analysis of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) Parameters in Young Adults after SARS-CoV-2 Infection (COVID-19) Compared with Healthy Young Controls. Diagnostics (Basel) 2023; 13:diagnostics13071283. [PMID: 37046498 PMCID: PMC10093659 DOI: 10.3390/diagnostics13071283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose: To compare retinal changes in young adults with previous SARS-CoV-2 infection with healthy young controls using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods: This prospective single-center study was conducted at the University Hospital of Zurich, Zurich, Switzerland. Participants were imaged from May to November 2021 using the SOLIX device (Visionix International SAS, Pont-de-l’Arche, France). We performed 12 mm × 12 mm, 6.4 mm × 6.4 mm, 6 mm × 6 mm and 3 mm × 3 mm OCT and OCTA scans, as well as fundus photography of each participant’s eyes. Results: In total, 466 participants were imaged. Of these, 233 were healthy controls with negative RT-PCR tests for SARS-CoV-2, 168 were young adults who had a SARS-CoV-2 infection at least 180 days previously, 19 were participants who had a SARS-CoV-2 infection < 180 days previously, and 46 were participants with asymptomatic SARS-CoV-2 infection (i.e., serologically positive but with no symptoms). Compared with healthy controls, statistically significant differences were found for OCTA recordings of the optic disc for the whole image (WI) and WI capillary vessel density, with both being higher in the SARS-CoV-2 group. Conclusion: Statistically significant results were only observed for selected variables, and in parts, only unilaterally, with relatively large p values (p = 0.02–0.03). Thus, we did not interpret these as clinically significant, leading to the conclusion that young and otherwise healthy individuals (mainly men) seem to recover from mild COVID-19 infections with no ophthalmological residues.
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Affiliation(s)
- Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | | | - Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Magdalena Rejdak
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sophia Sidhu
- Faculty of Medicine, University of California, San Diego, CA 92093, USA
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, 80138 Naples, Italy
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil, University Paris Est Creteil, 94000 Creteil, France
| | - Jeremy Werner Deuel
- Department of Global and Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
- Division of Medical Oncology and Haematology, University Hospital of Zurich, 8006 Zurich, Switzerland
| | - Patricia Schlagenhauf
- Department of Global and Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
- MilMedBiol—Centre of Competence for Military Medicine Biology, University of Zurich, 8006 Zurich, Switzerland
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-255-87-94
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Kal M, Winiarczyk M, Zarębska-Michaluk D, Odrobina D, Cieśla E, Płatkowska-Adamska B, Biskup M, Pabjan P, Głuszek S, Mackiewicz J. Long-Term Effect of SARS-CoV-2 Infection on the Retinal and Choroidal Microvasculature. J Clin Med 2023; 12:jcm12072528. [PMID: 37048610 PMCID: PMC10095143 DOI: 10.3390/jcm12072528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
The purpose of this study was to evaluate the persistent changes in microvascular parameters based on optical coherence tomography angiography (OCTA) in patients hospitalized due to COVID-19 bilateral pneumonia. The case-control prospective study was carried out among 49 patients with COVID-19 and 45 healthy age- and gender-matched 2 and 8 months after hospital discharge. We found a significantly decreased vessel density (VD) in superficial capillary plexus (SCP) in COVID-19 patients. Significantly decreased vessel density (VD) in the superficial capillary plexus (SCP), the deep capillary plexus (DCP), and choriocapillaris (CC), with significantly increased vessel density observed in the choriocapillaris in the foveal area (FCC). The foveal avascular zone in DCP (FAZd) was significantly increased in the COVID-19 group. We found differences between OCTA parameters according to gender. The foveal VD in SCP and DCP was significantly decreased in women compared to men. The FAZ area in SCP (FAZs) and superior VD in the choriocapillaris (SCC) were significantly increased in women. In conclusion, we noticed persistent changes in the ocular parameters of OCTA in COVID-19 patients. At the second follow-up visit, we observed a widened FAZ zone in SCP and decreased VD in some regions of the retina and choroid.
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Choroidal and Retinal Vascular Findings in Patients with COVID-19 Complicated with Pneumonia: Widefield Imaging. Diagnostics (Basel) 2023; 13:diagnostics13061114. [PMID: 36980424 PMCID: PMC10047816 DOI: 10.3390/diagnostics13061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose: The purpose of this study was to analyze choroidal and retinal vascular alterations of both the macula and midperiphery areas in patients hospitalized for COVID-19 infection complicated with pneumonia within 30 days from discharge. Methods: A total of 46 eyes of 23 subjects with a history of symptomatic COVID-19 infection and recent hospitalization for pneumonia were enrolled in this observational study. Patients had not been previously vaccinated against COVID-19. A group of patients homogenous for age and sex was enrolled as controls. Microvascular retinal and choroidal features of the enrolled patients were studied with widefield optical coherence tomography angiography (OCT-A). Perfusion parameters in terms of the vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and the choroidal vascularity index (CVI) on enhanced depth imaging (EDI) mode OCT scans were analyzed. Results: Our cohort of patients showed a trend of reduction in VD, significantly in the SCP VD of the superior and inferior midperiphery sectors, whereas the CVI did not show significant differences between the cases and controls. Moreover, a positive correlation between CVI and vessel density in the deep capillary plexus in the macular area (VD-DCP-MAC) was found. Conclusion: The systemic disease due to COVID-19 can also involve the retina and choroid with multiple mechanisms: ischemic and inflammatory. Our study showed changes in perfusion occurring in the eyes of patients with a recent hospitalization for COVID-19 complicated with pneumonia and without any possible ocular effect due to the vaccines. There is still the need to better comprise how long COVID-19 actually affects vascular changes in the eye.
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Albertos-Arranz H, Martínez-Gil N, Sánchez-Sáez X, Noailles A, Monferrer Adsuara C, Remolí Sargues L, Pérez-Santonja JJ, Lax P, Calvo Andrés R, Cuenca N. Microglia activation and neuronal alterations in retinas from COVID-19 patients: correlation with clinical parameters. EYE AND VISION (LONDON, ENGLAND) 2023; 10:12. [PMID: 36855168 PMCID: PMC9974399 DOI: 10.1186/s40662-023-00329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/08/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Different ocular alterations have been described in patients with coronavirus disease 2019 (COVID-19). Our aim was to determine whether COVID-19 affected retinal cells and establish correlations with clinical parameters. METHODS Retinal sections and flat-mount retinas from human donors with COVID-19 (n = 16) and controls (n = 15) were immunostained. The location of angiotensin-converting enzyme 2 (ACE2) and the morphology of microglial cells, Müller cells, astrocytes, and photoreceptors were analyzed by confocal microscopy. Microglial quantification and the area occupied by them were measured. Correlations among retinal and clinical parameters were calculated. RESULTS ACE2 was mainly located in the Müller cells, outer segment of cones and retinal pigment epithelium. Cell bodies of Müller cells in COVID-19 group showed greater staining of ACE2 and cellular retinaldehyde-binding protein (CRALBP). The 81.3% of COVID-19 patients presented disorganization of honeycomb-like pattern formed by Müller cells. Gliosis was detected in 56.3% of COVID-19 patients compared to controls (40%) as well as epiretinal membranes (ERMs) or astrocytes protruding (50%). Activated or ameboid-shape microglia was the main sign in the COVID-19 group (93.8%). Microglial migration towards the vessels was greater in the COVID-19 retinas (P < 0.05) and the area occupied by microglia was also reduced (P < 0.01) compared to control group. Cone degeneration was more severe in the COVID-19 group. Duration of the disease, age and respiratory failure were the most relevant clinical data in relation with retinal degeneration. CONCLUSIONS The retinas of patients with COVID-19 exhibit glial activation and neuronal alterations, mostly related to the inflammation, hypoxic conditions, and age.
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Affiliation(s)
- Henar Albertos-Arranz
- grid.5268.90000 0001 2168 1800Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig Road W/N, 03690 Alicante, Spain
| | - Natalia Martínez-Gil
- grid.5268.90000 0001 2168 1800Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig Road W/N, 03690 Alicante, Spain
| | - Xavier Sánchez-Sáez
- grid.5268.90000 0001 2168 1800Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig Road W/N, 03690 Alicante, Spain
| | - Agustina Noailles
- grid.5268.90000 0001 2168 1800Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig Road W/N, 03690 Alicante, Spain
| | - Clara Monferrer Adsuara
- grid.106023.60000 0004 1770 977XDepartment of Ophthalmology, General University Hospital Consortium of Valencia (CHGUV), 46014 Valencia, Spain
| | - Lidia Remolí Sargues
- grid.106023.60000 0004 1770 977XDepartment of Ophthalmology, General University Hospital Consortium of Valencia (CHGUV), 46014 Valencia, Spain
| | - Juan J. Pérez-Santonja
- grid.411086.a0000 0000 8875 8879Department of Ophthalmology, General University Hospital of Alicante (HGUA), 03010 Alicante, Spain ,grid.513062.30000 0004 8516 8274Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pedro Lax
- grid.5268.90000 0001 2168 1800Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig Road W/N, 03690 Alicante, Spain
| | - Ramón Calvo Andrés
- grid.106023.60000 0004 1770 977XDepartment of Ophthalmology, General University Hospital Consortium of Valencia (CHGUV), 46014 Valencia, Spain
| | - Nicolás Cuenca
- Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig Road W/N, 03690, Alicante, Spain. .,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain. .,National Institute of Health Carlos III (ISCIII), (RETICS) Cooperative Health Network for Research in Ophthalmology (Oftared), 28040, Madrid, Spain.
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Zicarelli F, Agarwal A, Rizzi C, Oldani M, Staurenghi G, Invernizzi A. Correlation Between Retinal Vessel Diameters and Uveitis Activity. Invest Ophthalmol Vis Sci 2023; 64:13. [PMID: 36877516 PMCID: PMC10007899 DOI: 10.1167/iovs.64.3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Purpose To assess retinal vein and artery diameters during active and inactive intraocular inflammation in eyes with uveitis. Methods Color fundus photographs and clinical data of eyes with uveitis collected during two visits (active disease [i.e., T0] and inactive stage [i.e., T1]) were reviewed. The images were semi-automatically analyzed to obtain the central retina vein equivalent (CRVE) and central retina artery equivalent (CRAE). Changes of CRVE and CRAE from T0 to T1 were calculated, and their possible correlation with clinical data, including age, gender, ethnicity, uveitis etiology, and visual acuity, were investigated. Results Eighty-nine eyes were enrolled in the study. Both CRVE and CRAE reduced from T0 to T1 (P < 0.0001 and P = 0.01, respectively), with active inflammation being able to influence the CRVE and CRAE (P < 0.0001 and P = 0.0004, respectively) after accounting for all other variables. The degree of venular (∆V) and arteriolar (∆A) dilation was influenced only by time (P = 0.03 and P = 0.04, respectively). Best-corrected visual acuity was influenced by time and ethnicity (P = 0.003 and P = 0.0006). Conclusions CRVE and CRAE are increased in eyes with active intraocular inflammation regardless of the type of uveitis, and they decrease when the inflammation wears off.
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Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Chiara Rizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Marta Oldani
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
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Boroojerdi MH, Al Jabry T, Mirarefin SMJ, Albalushi H. Insights into organoid-based modeling of COVID-19 pathology. Virol J 2023; 20:37. [PMID: 36841795 PMCID: PMC9959938 DOI: 10.1186/s12985-023-01996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
Since December 2019, various types of strategies have been applied due to the emergent need to investigate the biology and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to discover a functional treatment. Different disease modeling systems, such as mini-organ technology, have been used to improve our understanding of SARS-CoV-2 physiology and pathology. During the past 2 years, regenerative medicine research has shown the supportive role of organoid modeling in controlling coronavirus disease 2019 (COVID-19) through optimal drug and therapeutic approach improvement. Here, we overview some efforts that have been made to study SARS-CoV-2 by mimicking COVID-19 using stem cells. In addition, we summarize a perspective of drug development in COVID-19 treatment via organoid-based studies.
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Affiliation(s)
- Mohadese Hashem Boroojerdi
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Tariq Al Jabry
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Halima Albalushi
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
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Jevnikar K, Meglič A, Lapajne L, Logar M, Vidovič Valentinčič N, Globočnik Petrovič M, Jaki Mekjavić P. The Comparison of Retinal Microvascular Findings in Acute COVID-19 and 1-Year after Hospital Discharge Assessed with Multimodal Imaging-A Prospective Longitudinal Cohort Study. Int J Mol Sci 2023; 24:ijms24044032. [PMID: 36835445 PMCID: PMC9966689 DOI: 10.3390/ijms24044032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
This study aimed to quantify possible long-term impairment of the retinal microcirculation and microvasculature by reassessing a cohort of patients with acute COVID-19 without other known comorbidities one year after their discharge from the hospital. Thirty patients in the acute phase of COVID-19 without known systemic comorbidities were enrolled in this prospective longitudinal cohort study. Fundus photography, SS-OCT, and SS-OCTA using swept-source OCT (SS-OCT, Topcon DRI OCT Triton; Topcon Corp., Tokyo, Japan) were performed in the COVID-19 unit and 1-year after hospital discharge. The cohort's median age was 60 years (range 28-65) and 18 (60%) were male. Mean vein diameter (MVD) significantly decreased over time, from 134.8 μm in the acute phase to 112.4 μm at a 1-year follow-up (p < 0.001). A significantly reduced retinal nerve fiber layer (RNFL) thickness was observed at follow-up in the inferior quadrant of the inner ring (mean diff. 0.80 95% CI 0.01-1.60, p = 0.047) and inferior (mean diff. 1.56 95% CI 0.50-2.61, p < 0.001), nasal (mean diff. 2.21 95% CI 1.16-3.27, p < 0.001), and superior (mean diff. 1.69 95% CI 0.63-2.74, p < 0.001) quadrants of the outer ring. There were no statistically significant differences between the groups regarding vessel density of the superior and deep capillary plexuses. The transient dilatation of the retinal vessels in the acute phase of COVID-19, as well as RNFL thickness changes, could become a biomarker of angiopathy in patients with severe COVID-19.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andrej Meglič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Luka Lapajne
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Mateja Logar
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nataša Vidovič Valentinčič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Globočnik Petrovič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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Investigation of changes in retinal vascular parameters and choroidal vascular index values during the early recovery period of COVID-19: The COVID-OCTA study. Photodiagnosis Photodyn Ther 2023; 42:103338. [PMID: 36804945 PMCID: PMC9930379 DOI: 10.1016/j.pdpdt.2023.103338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND COVID-19 effects microvasculature in many tissues. This study investigated whether the choroidal structure is also affected. METHODS This cross-sectional study included 80 patients with COVID-19 and the same number of age- and gender-matched healthy individuals. All participants' right eye measurements were examined. Optical coherence tomography angiography (OCTA) was used for imaging. Otherwise, two independent researchers used the Choroidal vascular index (CVI) for choroidal parameters calculation. RESULTS Superior and deep flow values were lower in the COVID-19 group than in the control group, and vascular density (VD) values were lower in all regions in this group. Except for the superior mean VD, there was no statistically significant difference (p = 0.003). However, the COVID-19 group had significantly lower subfoveal choroidal thickness (SFChT) measurements than the control group (p = 0.001). In addition, no significant difference was observed between the groups in evaluating mean CVI values (p>0.05). CONCLUSION Noninvasive diagnostic tools such as OCTA and EDI-OCT can be used to monitor early changes in diseases affecting microvessels, such as from COVID-19.
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Bariş Üçer M, Cevher S. How does Covid-19 affect the choroidal structures at the early post-infectious period? J Fr Ophtalmol 2023; 46:106-113. [PMID: 36585332 PMCID: PMC9771749 DOI: 10.1016/j.jfo.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate choroidal thickness (CT) and choroidal vascularity index (CVI) in patients recovered from COVID-19 using enhanced depth imaging optical coherence tomography in the early postinfectious period. METHODS Sixty-five patients recovered from COVID-19 and 72 healthy subjects were included in the study. A full ophthalmic examination including best-corrected visual acuity (BCVA), slit lamp biomicroscopy, and dilated fundus examination was performed. CT was measured at 3 points as follows: subfoveal, 1000μm nasal and temporal to the fovea. The total choroidal area (TCA), luminal area (LA), stromal area (SA), and CVI were measured with Image-J. RESULTS The mean age was 39.09±11.27 years in the COVID-19 group and 39.61±11.43 years in the control group. The mean time from the first positive RT-PCR was 49.54±26.82 days (range 18-120) in the COVID-19 group. No statistically significant difference was detected between the groups with regard to axial length, spherical equivalent, and BCVA (all P>0.05). CT was found to be lower in the COVID-19 group compared to the control group in all quadrants, but this difference was not significant (all P>0.05). The mean TCA, LA, and CVI were statistically significantly reduced in the COVID-19 group (all P<0.001); however, SA showed no statistically significant difference (P=0.064). CONCLUSIONS In asymptomatic or mild COVID-19, CVI and LA decrease significantly, while CT thins in the early postinfectious period but not significantly.
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Akalin I, Kalkisim A, Gunay BO, Esenulku CM. Retinal Findings in Hospitalized COVID-19 Patients, Is Routine Ophthalmological Examination Required after Discharge? Prospective Case-Control Study. Klin Monbl Augenheilkd 2023; 240:169-179. [PMID: 36634686 DOI: 10.1055/a-1964-7596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To investigate retinal findings by comparing patients hospitalized for COVID-19 with the control group. METHODS In this prospective study, 188 eyes of 94 recovered COVID-19 patients and 108 eyes of 54 healthy participants as a control group were evaluated. Patients were divided into three groups, those with mild, moderate, and severe COVID-19. Refractometry, tonometry, optical biometry, optical coherence tomography (OCT) measurements, and complete ophthalmological examinations were performed on healthy volunteers and COVID-19 patients on average 2 weeks after discharge. Pulse O2 and vital parameters were also assessed. Primary outcomes were evaluated, such as retinal findings, and secondary outcomes as retinal thickness, choroidal thickness (CT), retinal nerve fiber layer thickness, and ganglion cell layer thickness. RESULTS There was no difference between the groups in terms of demographic data, ocular biometry, and intraocular pressure (p > 0.05). Pulse O2 was lower in the study group (p < 0.001). Retinal findings were detected in 68 (36.1%) of 188 eyes in the study group and 28 (25.9%) of 108 eyes in the control group (p = 0.07). The two most common retinal findings were hypertensive retinopathy and retinal pigment epithelium alterations and/or drusen in both groups. In OCT measurements, significant thinning was observed in nasal macular thickness and superior 2 mm CT in the study group compared to the control group (p < 0.05). In patients divided into subgroups according to disease severity, no significant difference was found between the groups in any OCT parameter (p > 0.05). CONCLUSION It has been observed that COVID-19 infection does not cause a specific and sensitive finding in the ocular tissues, especially the retina, and does not produce a reproducible measurement result. Recommending routine eye exam after COVID-19 does not seem cost-effective.
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Affiliation(s)
- Irfan Akalin
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ahmet Kalkisim
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Betul Onal Gunay
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Cenap Mahmut Esenulku
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
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Kamalipour A, Ashraf MA, Moghimi S, Moattari A, Ashraf MJ, Abbasi F, Azodi F, Oboudi S, Pirbonyeh N, Mokhtaryan M, Roshanshad A, Do JL, Weinreb RN. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA in the Human Eye. Ocul Immunol Inflamm 2023; 31:32-38. [PMID: 34637665 DOI: 10.1080/09273948.2021.1980810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in postmortem ocular specimens of patients with severe COVID-19 disease. PATIENTS AND METHODS Postmortem conjunctival (28 samples), aqueous humor (30 samples) and vitreous humor (30 samples) specimens were obtained bilaterally from the eyes of 15 deceased COVID-19 patients within one hour of death. The presence of viral RNA was evaluated in samples using Real-time reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS Positive RT-PCR SARS-COV-2 results were found in one conjunctival and 2 vitreous humor samples. All aqueous humor samples tested negative for the presence of SARS-COV-2 RNA. Of note, three positive samples were obtained from three different patients. The overall prevalence of positive RT-PCR ocular samples was 3.4% among all samples and 20% at the patient level. CONCLUSION SARS-CoV-2 RNA is detectable in postmortem conjunctival and vitreous humor samples of patients with severe COVID-19.
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Affiliation(s)
- Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA
| | - Mohammad Ali Ashraf
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA
| | - Afagh Moattari
- Department of Virology and Bacteriology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Bioinformatics and Computational Biology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Ashraf
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Abbasi
- Department of Infectious Diseases, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Farzan Azodi
- Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Shadi Oboudi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pirbonyeh
- Department of Virology and Bacteriology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Microbiology, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Mokhtaryan
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Roshanshad
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jiun L Do
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA
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Adzic Zecevic A, Vukovic D, Djurovic M, Lutovac Z, Zecevic K. Multiple Evanescent White Dot Syndrome Associated with Coronavirus Infection: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:98-101. [PMID: 36688189 PMCID: PMC9843462 DOI: 10.30476/ijms.2022.95007.2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/05/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023]
Abstract
Coronavirus disease 2019 (COVID-19) causes ocular manifestations in approximately 11% of patients. Most patients typically develop ocular symptoms within 30 days of the onset of the first COVID-19 symptoms. The most common ocular manifestation is conjunctivitis, which affects nearly 89% of patients with eye problems. Other much less common anterior segment abnormalities caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are scleritis, episcleritis, and acute anterior uveitis. Posterior segment abnormalities caused by SARS-CoV-2 are mainly vascular, such as hemorrhages, cotton wool spots, dilated veins, and vasculitis. Herein, we report a rare manifestation of COVID-19 and multiple evanescent white dot syndrome (MEWDS) of the retina. In April 2021, a 40-year-old female patient was admitted to the Eye Clinic of Clinical Center of Montenegro (Podgorica, Montenegro). The patient's main complaint was sudden vision impairment, which occurred 14 days after a positive polymerase chain reaction (PCR) test result for SARS-CoV-2 infection. A complete eye examination was performed, followed by fundoscopy, optical coherence tomography (OCT), and fluorescein angiography (FA) tests. The results showed retinal changes associated with MEWDS. The patient underwent additional examinations to rule out common causes of multifocal retinitis, all of which were unremarkable. Therefore, it was concluded that retinitis was a complication of COVID-19. Given its non-invasive nature, fundus examination should be used as a standard screening method for retinal changes in patients with COVID-19.
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Affiliation(s)
- Antoaneta Adzic Zecevic
- Eye Clinic, Clinical Center of Montenegro and Medical Faculty, University of Montenegro, Podgorica, Montenegro
| | | | - Maja Djurovic
- Eye Clinic, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Ksenija Zecevic
- School of Medicine, University of Montenegro, Podgorica, Montenegro
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Muacevic A, Adler JR, Kumar S, Jaisingh K, R. AT, Rao KC, Chhabra K, Saxena S, Manchanda V, Sharma S. Optical Coherence Tomography Angiography Parameters of the Retina in SARS-CoV-2 Recovered Subjects. Cureus 2023; 15:e33548. [PMID: 36779162 PMCID: PMC9907863 DOI: 10.7759/cureus.33548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION This study aims to evaluate retinochoroidal optical coherence tomography angiography (OCTA) parameters in patients recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS This study was an observational study that included 80 subjects being discharged after having negative reports on the reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 to evaluate OCTA parameters of the retina. The subjects underwent an ophthalmic evaluation that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), color vision (CV), contrast sensitivity (CS), and optical coherence tomography (OCT) parameters. OCTA was done for all patients and was evaluated for foveal avascular zone (FAZ) area, perimeter, and circularity index, and vessel density (VD) in superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), outer retina chorio-capillaries (ORCC), chorio-capillaries (CC), and choroid (C) using 3 x 3 mm scans. The OCTA parameters were compared with normative data of the Indian population for various parameters in question. RESULTS The subjects included 54/80 (67.5%) males and 26/80 (32.5%) females having a mean age of 52.40 ± 15.71 (18-60) years. The systemic evaluation revealed 38.75% of subjects had hypertension, 30% had diabetes, 20% had kidney disease, 5% had tuberculosis, and 3.75% had coronary artery disease. The mean distance BCVA was logarithm of the minimum angle of resolution (LogMAR) (1.17 ± 0.22), mean IOP was 17.0 ± 4.0 mmHg, mean CS was 2.13 ± 0.36, 50.62% of subjects had normal CV on Farnsworth test while 47% had tritanopia, and none of the subjects had red-green CV defect on Ishihara plates. The OCT scan was normal in 90% of eyes while the posterior vitreous detachment was seen in 4% of eyes, broad vitreomacular adhesion in 2.5% of eyes, and the globally adherent epiretinal membrane was seen in 2.5% of eyes. The mean central macular thickness (CMT) measured 245.14 ± 28.41 micrometers. The mean FAZ area measured 0.37 ± 0.15 mm2, the perimeter was 3.28 ± 1.08 mm, and the circularity index measured 0.41 ± 0.10. The average VD in SCP measured 16.06 ± 12.29, in DCP measured 9.11 ± 8.75, in OR measured 6.38 ± 7.37, in ORCC measured 42.53 ± 12.46, in CC measured 25.83 ± 16.31, and in C measured 25.52 ± 17.49. The VD in coronavirus disease 2019 (COVID-19) subjects was significantly lesser than that in the healthy Indian population in all layers except ORCC. CONCLUSIONS The SARS-CoV-2 recovered subjects have a reduced VD in retinochoroidal layers from COVID-19, an underlying systemic disease, or both. The CS values fall within normal limits. Several subjects show tritanopia on the Farnsworth test but no red-green CV defect on Ishihara plates.
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Loduca Lima V, Soares LCM, Pereira LA, Nascimento PA, Cirillo LRN, Sakuma HT, da Veiga GL, Abucham-Neto JZ, Fonseca FLA. Ophthalmic Manifestations Among Patients Surviving COVID-19. Int J Gen Med 2023; 16:1747-1755. [PMID: 37193252 PMCID: PMC10182800 DOI: 10.2147/ijgm.s399806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/20/2023] [Indexed: 05/18/2023] Open
Abstract
Background and Aim To identify ocular findings related to SARS-CoV-2 infection in patients after the resolution of COVID-19 using complete ocular examinations and optical coherence tomography (OCT). Methods In this cross-sectional study, conducted from May 30 to October 30, 2020, patients who recovered from various stages COVID-19 underwent eye examination and multimodal retinal imaging (Retinographies and Spectral-OCT). Results We included 50 patients, 29 (58%) males, median age of 46.5 [standard deviation 15.8]. Of these, 42% (21) had mild, 18% (9) had severe and 40% (20) had critical disease. The median time interquartile range (IQR) between symptom onset and ocular examination was 55 days [IQR 39-71]. Seven patients (14%) reported ophthalmic symptoms, transitory low visual acuity (6%) and retroocular pain (8%). On OCT, one patient without comorbidities had sectoral retinal pallor suggestive of acute retinal ischaemia and oedema of the retina's inner layers and atrophy. All findings progressively and spontaneously improved months after resolution of COVID-19. Conclusion Patients with COVID-19 present findings compatible with the general population depending on age and comorbidities; nevertheless, acute retinal findings associated with the disease may be present, such as caused either by the direct effects of retinal SARS-CoV-2 infection, by indirect effects of the cytokine storm or by the pro-thrombotic state associated with COVID-19. Therefore, retinal involvement in patients with COVID-19 remains subject to considerable discussion and study.
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Affiliation(s)
- Vagner Loduca Lima
- Departamento de Oftalmologia, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | | | | | | | - Glaucia Luciano da Veiga
- Departamento de Oftalmologia, Faculdade de Medicina do ABC, Santo André, Brazil
- Laboratório de Análises Clínicas, Faculdade de Medicina do ABC, Santo André, Brasil
- Correspondence: Glaucia Luciano da Veiga, Departamento de Oftalmologia, Faculdade de Medicina ABC, 2000 Lauro Gomes Avenue, Santo André, SP, 09069-870, Brazil, Tel +55 11 4993-5488, Email
| | | | - Fernando Luiz Affonso Fonseca
- Departamento de Oftalmologia, Faculdade de Medicina do ABC, Santo André, Brazil
- Laboratório de Análises Clínicas, Faculdade de Medicina do ABC, Santo André, Brasil
- Departamento de Ciências Farmacêuticas da Universidade Federal de São Paulo/UNIFESP, Diadema, Brasil
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Relationship of the main indicators of systemic COVID-associated endotheliopathy with the morphofunctional state and hemodynamics of the retina and chorioid in the acute period of the disease. OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov110727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND: Nonspecific angio- and retinopathy is one of the clinical manifestations of a new coronavirus infection. The frequency of occurrence of these changes in people with severe COVID-19 does not exceed 55%. The causes, course and consequences of these microcirculatory disorders of the retina are currently not well understood.
AIM: To study and compare of retinal morphometric parameters and systemic endothelial dysfunction markers, as well as the main clinical and laboratory parameters in patients with moderate and severe coronavirus infection during convalescence.
MATERIALS AND METHODS: The study involved 44 patients (86 eyes) who had COVID-19 during the previous 3 months, who were divided into 2 groups: with moderate and severe disease. The control group consisted of 18 healthy volunteers (36 eyes). All patients underwent a standard ophthalmological examination and optical coherence tomography, which included an assessment of the choroidal thickness (CT) and measurement of the mean diameter of the peripapillary arteries (MAD) and veins (MVD). During hospitalization, all patients underwent a laboratory study of venous blood parameters, as well as an assessment of the microcirculation of the sublingual plexus by examining the density of the endothelial glycocalyx (PBR) using the GlycoCheck.
RESULTS: In patients who underwent COVID-19, there was a significant increase in CT relative to the control group, amounting to 308, 344 and 392 m, respectively. The most pronounced difference was observed between MVD in patients with severe infection and the control group (119.1 m vs. 99.2 m). In patients with moderate and severe COVID-19, MAD and MVD were positively correlated with TC, with r = 0.389 and r = 0.584, respectively. MVD also correlated with the level of leukocytes (r = 0.504), the ESR value (r = 0.656). Correlations between MVD and data characterizing the state of the glycocalyx in the sublingual vascular plexus were revealed: the filling of small capillaries with erythrocytes (r = 0.587), as well as the marginal perfusion value in large capillaries 2025 m (r = 0.479) and PBR (r = 0.479). Only significant differences and correlations are shown (p 0.005).
CONCLUSIONS: In patients who underwent moderate and severe COVID-19 during the convalescence period (up to 30 days), an increase in the diameter of peripapillary vessels and TC is observed, proportional to the severity of COVID-19, laboratory markers of systemic inflammation and hypercoagulation (the number of leukocytes, the ESR value, D-dimer and prothrombin), which indicates the inflammatory nature of the changes. The severity of postcovid retinal microangiopathy correlates with indicators detecting a decreasing of the endothelial glycocalyx thickness in the sublingual capillary plexus, which indirectly indicates a connection with systemic endotheliopathy.
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Khan HA, Shahzad MA, Jahangir S, Iqbal J, Juwa SA, Khan QA, Khan N, Afzal M, Iqbal F. Eyelid Myokymia—a Presumed Manifestation of Coronavirus Disease 2019 (COVID-19). SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:29. [PMID: 35036848 PMCID: PMC8743236 DOI: 10.1007/s42399-021-01094-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/29/2022]
Abstract
The purpose of this study is to report eyelid myokymia in patients recently recovered from COVID-19 disease. A cohort of 15 patients who developed eyelid myokymia during or immediate post-recovery of systemic disease were evaluated. Demographic, clinical characteristics, effect of age, and hospitalization on the disease course were studied. The disease course was evaluated every month for 3 months period. All, except 2, patients had complete resolution of lid myokymia within 3 months of onset. Median [IQR] myokymia recovery time was 42 [31,60] days. Age and duration of hospitalization had a significant linear relationship with myokymia recovery time. Recovery was delayed by 2.64 days with every 1-year increment in age and by 6.19 days with every additional day of hospital stay. Recovery time was independent of severity of systemic disease (P = .055) and gender (P = 0.2). Eyelid myokymia can be a possible manifestation of COVID-19 recovery phase. While myokymia recovers gradually in all these patients, older age and a longer duration of hospitalization are associated with slower recovery.
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Affiliation(s)
- Hashim Ali Khan
- Department of Ophthalmology, SEHHAT Foundation Hospital, Main KKH, Danyore, Gilgit Pakistan
- School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
| | | | - Smaha Jahangir
- School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
| | - Junaid Iqbal
- Department of Ophthalmology, SEHHAT Foundation Hospital, Main KKH, Danyore, Gilgit Pakistan
| | - Suhail Abbas Juwa
- Department of Ophthalmology, SEHHAT Foundation Hospital, Main KKH, Danyore, Gilgit Pakistan
| | - Qaim Ali Khan
- Department of Ophthalmology, Agha Khan Health Services, Gilgit, Pakistan
| | | | | | - Fatima Iqbal
- School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
- School of Optometry, University of New South Wales, Sydney, Australia
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