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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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Lin TPH, Sen M, Gupta V, Agrawal R, Lanzetta P, Giannaccare G, Chan CKM, Agrawal K, Menia NK, Rojas-Carabali W, Arora A, Martinuzzi D, Taloni A, Rubinato L, Coco G, Sarao V, Veritti D, Chen L, Honavar SG, Lam DSC. Update on coronavirus disease 2019: Ophthalmic Manifestations and Adverse Reactions to Vaccination. Asia Pac J Ophthalmol (Phila) 2023; 12:512-536. [PMID: 38117598 DOI: 10.1097/apo.0000000000000647] [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: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 12/22/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 was one of the most devastating public health issues in recent decades. The ophthalmology community is as concerned about the COVID-19 pandemic as the global public health community is, as COVID-19 was recognized to affect multiple organs in the human body, including the eyes, early in the course of the outbreak. Ophthalmic manifestations of COVID-19 are highly variable and could range from mild ocular surface abnormalities to potentially sight and life-threatening orbital and neuro-ophthalmic diseases. Furthermore, ophthalmic manifestations may also be the presenting or the only findings in COVID-19 infections. Meanwhile, global vaccination campaigns to attain herd immunity in different populations are the major strategy to mitigate the pandemic. As novel vaccinations against COVID-19 emerged, so were reports on adverse ophthalmic reactions potentially related to such. As the world enters a post-pandemic state where COVID-19 continues to exist and evolve as an endemic globally, the ophthalmology community ought to be aware of and keep abreast of the latest knowledge of ophthalmic associations with COVID-19 and its vaccinations. This review is a summary of the latest literature on the ophthalmic manifestations of COVID-19 and the adverse ophthalmic reactions related to its vaccinations.
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Affiliation(s)
- Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Mrittika Sen
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Raghunath Netralaya, Mumbai, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Duke NUS Medical School, National University of Singapore, Singapore
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kajal Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
| | - Nitin Kumar Menia
- All India Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - William Rojas-Carabali
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Andrea Taloni
- University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Leopoldo Rubinato
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Lizhen Chen
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Santosh G Honavar
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Centre for Sight Eye Hospital, Hyderabad, India
| | - Dennis S C Lam
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
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Bousquet E, Santina A, Abraham N, Daily MJ, Sarraf D. Detection of Paracentral Acute Middle Maculopathy Can Prevent Blindness and Death. Retina 2023; 43:1827-1832. [PMID: 37748460 DOI: 10.1097/iae.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Elodie Bousquet
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Ahmad Santina
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Neda Abraham
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | | | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
- Greater Los Angeles Virginia Healthcare Center, Los Angeles, California
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Mitamura M, Kase S, Hirooka K, Endo H, Ito Y, Ishida S. Choroidal Circulatory and Vascular Morphological Changes in Acute Macular Neuroretinopathy After Infection With Severe Acute Respiratory Syndrome Coronavirus 2: A Case Report With Literature Review. In Vivo 2023; 37:2869-2876. [PMID: 37905626 PMCID: PMC10621410 DOI: 10.21873/invivo.13405] [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: 08/01/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM The aim of this study was to analyze choroidal circulatory and structural changes using laser speckle flowgraphy (LSFG) and optical coherence tomography (OCT) in acute macular neuroretinopathy (AMN) after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respectively. CASE REPORT A 24-year-old woman complained of distorted vision after SARS-CoV-2 infection oculi uterque (OU) and referred to our hospital because of ellipsoid zones (EZ) disruption on OCT. Her best-corrected visual acuity (BCVA) was 1.2 OU. Color fundus photographs revealed dark red lesions in the macula, and scanning laser ophthalmoscopy infrared images showed hypointensity consistent with dark red lesions OU. We diagnosed the patient with AMN after SARS-CoV-2 infection, and posterior sub-Tenon injections of triamcinolone acetonide were performed OU. Five months after the initial visit, her BCVA was 1.2 OU, and EZ disruption improved. The rate of change in macular blood flow assessed by the mean blur rate on LSFG was 20.4% and 29.6% increase oculus dexter (OD) and oculus sinister (OS) 5 months after the initial visit, respectively. The central choroidal thickness showed 13.5% increase OD and 16.1% increase OS. The binarization technique demonstrated that the ratio of luminal areas in choroidal area increased by 12.6% OD and 14.2% OS, and stromal areas increased by 7.3% OD and 16.9% OS. CONCLUSION Before and after treatment for AMN, the luminal component may have increased with improvement of acute choroidal circulatory disturbance caused by SARS-CoV-2, and increased stromal components may be due to chronic inflammation and tissue remodeling of the stroma.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan;
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Endo
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yuki Ito
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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