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Szalai E, Nagy K, Kolkedi Z, Csutak A. Corneal nerve fiber morphology following COVID-19 infection in vaccinated and non-vaccinated population. Sci Rep 2024; 14:16801. [PMID: 39039160 PMCID: PMC11263336 DOI: 10.1038/s41598-024-67967-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: 02/24/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024] Open
Abstract
To examine corneal subbasal nerve changes in patients who received vaccination against SARS-CoV-2 virus and underwent COVID-19 infection compared to infected non-vaccinated patients and healthy controls. Twenty-nine eyes of 29 vaccinated patients (mean age: 36.66 ± 12.25 years) within six months after PCR or Ag test proven COVID-19 infection and twenty-eight eyes of 28 age-matched infected, non-vaccinated patients (mean age: 42.14 ± 14.17 years) were enrolled. Twenty-five age-matched healthy individuals (mean age: 47.52 ± 18.45 years) served as controls. In vivo confocal microscopy (Heidelberg Retina Tomograph II Rostock Cornea Module, Germany) was performed in each group. Corneal subbasal nerve plexus morphology and corneal dendritic cells (DC) were evaluated. Significantly higher corneal nerve fiber density (P < 0.001), nerve branch density (P < 0.001), nerve fiber length (P < 0.001), total branch density (P = 0.007), nerve fiber area (P = 0.001) and fractal dimension (P < 0.001) values were observed in vaccinated patients after COVID-19 infection compared to the non-vaccinated group. Significantly higher DC density was observed in the non-vaccinated group compared to the control group (P = 0.05). There was a statistically significant difference in the size of mature DCs (P < 0.0001) but the size of immature DCs did not differ significantly among the 3 groups (P = 0.132). Our results suggest that SARS-CoV-2 vaccination may have a protective effect against the complications of COVID-19 disease on the corneal subbasal nerve fibers.
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Affiliation(s)
- Eszter Szalai
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary.
| | - Katalin Nagy
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary
| | - Zsofia Kolkedi
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary
| | - Adrienne Csutak
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary
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Litt J, Cunningham AL, Arnalich-Montiel F, Parikh R. Herpes Zoster Ophthalmicus: Presentation, Complications, Treatment, and Prevention. Infect Dis Ther 2024; 13:1439-1459. [PMID: 38834857 PMCID: PMC11219696 DOI: 10.1007/s40121-024-00990-7] [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: 01/17/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
Herpes zoster (HZ) is caused by reactivation of latent infection of varicella zoster virus (VZV) in sensory (cranial, dorsal root) ganglia. Major risk factors for HZ are increasing age and immunosuppression. HZ ophthalmicus (HZO) is a subset of HZ with involvement of the ophthalmic division of the fifth cranial trigeminal nerve. Approximately 4-20% of patients with HZ develop HZO. Approximately 50% of patients with HZO develop ocular disease, among whom up to 25% develop chronic or recurrent disease. Common manifestations of ocular disease include conjunctivitis, keratitis, and uveitis, whereas optic neuropathy and retinitis are uncommon. Due to the potential for vision impairment, ocular involvement requires urgent ophthalmic consultation. Early recognition and timely treatment with antivirals may prevent ocular complications. HZO is preventable by vaccination against HZ. Vaccine efficacy/effectiveness studies have been largely conducted for HZ with few studies assessing HZO. Both the recombinant adjuvanted vaccine (RZV) and live-attenuated vaccine (ZVL) significantly reduce the incidence of HZ and HZO in older adults. RZV is more effective than ZVL. Data on the effectiveness of vaccines for prevention of recurrent disease in patients with HZO are limited; however, vaccination is recommended. Despite recommendations to vaccinate individuals likely to benefit from an HZ vaccine, coverage for adults remains suboptimal. Barriers to vaccination include patient beliefs about HZ or HZ vaccines, and factors related to healthcare providers. In particular, the lack of a recommendation from their primary care physician is often cited by patients as a reason for remaining unvaccinated. By encouraging vaccination against HZ, physicians not only prevent HZ and HZO but also potential vision loss due to HZO.Graphical abstract available for this article.
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Affiliation(s)
- John Litt
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Anthony L Cunningham
- Westmead Institute for Medical Research and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Francisco Arnalich-Montiel
- Cornea Unit, Department of Ophthalmology, Ramón y Cajal University Hospital, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Ceu San Pablo, Campus de Montepríncipe, Boadilla, Spain
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Gupta PC, Padhi BK, Abu Serhan H, Dziedzic A, Khatib MN, Gaidhane S, Zahiruddin QS, Gaidhane AM, Kukreti N, Rustagi S, Satapathy P. Risk of Corneal Transplant Rejection Following COVID-19 Vaccination: A Systematic Review and Meta-analysis. Ophthalmol Ther 2024; 13:1635-1645. [PMID: 38627321 PMCID: PMC11109062 DOI: 10.1007/s40123-024-00941-y] [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: 03/05/2024] [Accepted: 03/25/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has initiated an unparalleled global vaccination campaign, raising concerns about the vaccine's effects on various health conditions, including the risk of corneal transplant rejection. This systematic review aimed to identify the relationship between COVID-19 vaccination and rejection of corneal transplant, filling a significant gap in the existing medical literature. METHODS A literature search was performed across multiple databases up to February 12, 2024, to identify studies evaluating the risk of corneal transplant rejection post-COVID-19 vaccination. Eligible studies were original research that reported outcomes of corneal graft rejection following vaccination. Nested Knowledge web software facilitated screening and data extraction. The Newcastle-Ottawa Scale was employed for quality assessment. A meta-analysis was conducted to calculate the aggregated relative risk (RR) utilizing R software version 4.3. RESULTS Six studies were included in the qualitative synthesis, with four meeting the criteria for meta-analysis. These studies varied in geographic location, surgical techniques, and types of vaccines used. The pooled RR for corneal transplant rejection following COVID-19 vaccination was 0.816 (95% CI 0.178-1.453), indicating no significant risk of rejection. No statistical heterogeneity was observed among the studies (I2 = 0%). CONCLUSIONS This review and meta-analysis found no significant evidence that COVID-19 vaccination increases the risk of corneal graft rejection. However, the current evidence is insufficient to conclusively determine the vaccine's safety for corneal transplant recipients. These findings underscore the need for additional research to confirm these preliminary results and investigate the long-term effects of COVID-19 vaccination on corneal transplants, aiming to provide evidence-based guidance to healthcare providers and patients.
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Affiliation(s)
- Parul Chawla Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Arkadiusz Dziedzic
- Department of Conservative Dentistry with Endodontics, Medical University of Silesia, 40-055, Katowice, Poland
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, South Asia Infant Feeding Research Network (SAIFRN), Datta Meghe Institute of Higher Education, Wardha, India
| | - Abhay M Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, and Global Health Academy, Datta Meghe Institute of Higher Education, Wardha, India
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq
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Musa M, Enaholo E, Aluyi-Osa G, Atuanya GN, Spadea L, Salati C, Zeppieri M. Herpes simplex keratitis: A brief clinical overview. World J Virol 2024; 13:89934. [PMID: 38616855 PMCID: PMC11008405 DOI: 10.5501/wjv.v13.i1.89934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/28/2023] [Accepted: 01/22/2024] [Indexed: 03/11/2024] Open
Abstract
The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre, Km 7, Benin 300105, Nigeria
| | - Ehimare Enaholo
- Department of Ophthalmology, Africa Eye Laser Centre, Km 7, Benin 300105, Nigeria
- Department of Ophthalmology, Centre for Sight Africa, Nkpor 434101, Nigeria
| | - Gladness Aluyi-Osa
- Department of Ophthalmology, Africa Eye Laser Centre, Km 7, Benin 300105, Nigeria
| | | | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Parikh R, Yousefi M, Curran D, Widenmaier R. The Impact of the COVID-19 Pandemic on the Incidence of Herpes Zoster: A Narrative Literature Review. Infect Dis Ther 2024; 13:447-461. [PMID: 38441844 DOI: 10.1007/s40121-024-00924-3] [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: 09/27/2023] [Accepted: 01/15/2024] [Indexed: 03/27/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) has had a broad impact on health services and health outcomes. During the pandemic, there were numerous reports of herpes zoster (HZ) in people with COVID-19 and in COVID-19 vaccine recipients. The aim of this review is to elucidate the global effects of the COVID-19 pandemic on HZ. It is postulated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces an immunosuppressive state that favours varicella zoster virus (VZV) reactivation. Three large cohort studies (a multinational study and studies from the USA and Spain) that excluded individuals vaccinated against HZ reported significantly increased risk of HZ following COVID-19 infection, especially in people aged ≥ 50 years. In contrast, a large study from Israel that did not consider HZ vaccination status reported no such increase. Cases of HZ following COVID-19 vaccination have been reported and may be the result of attenuated cell-mediated immunity. This phenomenon appears to vary by vaccine type. Some (but not all) large analyses have reported a significant positive relationship between receipt of mRNA vaccines for COVID-19 and development of HZ. These include analyses of health records databases in Israel and Hong Kong and of spontaneous case reports in the US Vaccine Adverse Event Reporting System (VAERS) database. Routine vaccinations, including shingles vaccine programmes, were disrupted by the COVID-19 pandemic. It is estimated that missed shingles vaccinations may have resulted in 63,117 avoidable HZ cases in the USA. Now that the World Health Organization has declared an end to the COVID-19 pandemic as a health emergency and routine vaccination services have resumed, there is a need to increase awareness of HZ and HZ vaccination.Graphical abstract available for this article.
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Allen NE, Zhang J, McGhee CNJ. COVID-19 vaccination and corneal allograft rejection- a review. Front Cell Infect Microbiol 2023; 13:1307655. [PMID: 38162575 PMCID: PMC10757323 DOI: 10.3389/fcimb.2023.1307655] [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: 10/05/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Aim To provide a comprehensive literature review on the perceived correlation between COVID-19 vaccination and corneal allograft rejection, and to characterize risk factors, time course, graft outcomes and proposed immunological basis. Methods A literature review was conducted in August 2023 using 4 electronic databases: PubMed, EMBASE, MEDLINE and Scopus. Articles were sourced using key words associated with COVID-19 vaccination and corneal graft. All articles were screened for relevance by abstract review. Duplicates and articles related to COVID-19 infection were excluded. No time limits were set. Additional literature searches regarding cause of corneal graft rejection, rates of graft rejection associated with other vaccines and the cellular mechanism of rejection were also performed. Results 262 articles were identified from the literature search. 37 papers were included in the analysis based on defined inclusion criteria. This consisted of systematic reviews (n=6), review articles (n=5), retrospective studies (n=3), case series (n=8), letter to the editor (n=1) and case reports (n= 14). The majority of reported allograft rejections were in penetrating keratoplasties. Risk factors for COVID-19 vaccination associated rejection were previous allograft rejection episodes, repeat grafts and penetrating keratoplasty. Most reported rejection episodes were mild and resolved with treatment. Notably, several studies reported nil increase in corneal allograft rejection episodes over the COVID-19 vaccination period. Rejection episodes are associated with a broad spectrum of other vaccines and the complete pathophysiology is undetermined. Conclusion Corneal allograft rejection appears to be a rare complication of COVID-19 vaccination most frequently observed in high-risk corneal transplants. The true extent of this correlation remains controversial; however, clinician awareness of this risk is essential to its mitigation. Patient counselling around symptom monitoring following vaccination and discussion around topical steroid prophylaxis may be prudent.
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Affiliation(s)
| | | | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Hutchinson KA, Peretz D, Darvish M, Talajic J, Choremis J. Rare Case of Thygeson Superficial Punctate Keratitis After COVID-19 Vaccination. Cornea 2023; 42:1306-1308. [PMID: 37399572 DOI: 10.1097/ico.0000000000003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/22/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE The aim of this study was to elucidate a rare corneal association of the coronavirus disease 2019 (COVID-19) vaccine. Although cases of corneal involvement after vaccination have been reported, we present the first case of Thygeson superficial punctate keratitis (TSPK) linked to the COVID-19 vaccine. METHODS This study is a case report. RESULTS A 25-year-old woman was assessed in the ophthalmology clinic for recurrent ocular surface symptoms after receiving the COVID-19 vaccine. She was followed in clinic and was found to have a remitting and recurring pattern of bilateral intraepithelial corneal opacities with associated subepithelial haze primarily overlying the pupillary area. These corneal lesions responded well to topical corticosteroid ophthalmic drops. Based on the clinical appearance, the response to treatment, negative herpes simplex virus serology, and the temporal relationship between vaccination and ocular findings, a diagnosis of COVID-19 vaccine-induced TSPK was suspected. CONCLUSIONS Although the COVID-19 vaccine remains overwhelmingly safe, clinicians should be aware of possible corneal side effects, including TSPK. Prompt ophthalmic assessment in those presenting with ocular symptoms after vaccination is encouraged.
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Affiliation(s)
- Kelly Ann Hutchinson
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Daniel Peretz
- Faculty of Medicine and Health Sciences, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada; and
| | - Mahshad Darvish
- Faculty of Medicine and Health Sciences, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada; and
| | - Julia Talajic
- Département d'ophtalmologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Johanna Choremis
- Faculty of Medicine and Health Sciences, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada; and
- Département d'ophtalmologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
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Roncati L, Sweidan E, Tchawa C, Gianotti G, Di Massa G, Siciliano F, Paolini A. SARS-CoV-2 Induced Herpes Virus Reactivations and Related Implications in Oncohematology: When Lymphocytopenia Sets in and Immunosurveillance Drops Out. Microorganisms 2023; 11:2223. [PMID: 37764067 PMCID: PMC10534535 DOI: 10.3390/microorganisms11092223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/01/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2), is a positive-sense single-stranded ribonucleic acid (RNA) virus contagious in humans and responsible for the ongoing coronavirus disease 2019 (COVID-19) [...].
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Affiliation(s)
- Luca Roncati
- Institute of Pathology, Department of Laboratory Medicine and Anatomical Pathology, University Hospital of Modena—Polyclinic, 41124 Modena, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Elizabeth Sweidan
- Graduate School of Anatomical Pathology, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Cyrielle Tchawa
- Graduate School of Medical Oncology, Department of Maternal, Infant and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Greta Gianotti
- Institute of Pathology, Department of Laboratory Medicine and Anatomical Pathology, University Hospital of Modena—Polyclinic, 41124 Modena, Italy
- Graduate School of Anatomical Pathology, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Gianluca Di Massa
- Institute of Pathology, Department of Laboratory Medicine and Anatomical Pathology, University Hospital of Modena—Polyclinic, 41124 Modena, Italy
- Graduate School of Anatomical Pathology, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Flavia Siciliano
- Graduate School of Medical Oncology, Department of Maternal, Infant and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Ambra Paolini
- Unit of Diagnostic Hematology, Department of Laboratory Medicine and Anatomical Pathology, University Hospital of Modena—Polyclinic, 41124 Modena, Italy
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