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Elsakka MM, Moawad MHED, Labeeb EE, Elneny M, Siddiq A, Gahlan S, Alkhawaldeh IM, Abu Serhan H. Chorioretinopathy Post COVID-19: A Systematic Review and Prevalence Assessment, Unveiling Insights into an Emerging Ocular Entity. Semin Ophthalmol 2024; 39:353-363. [PMID: 38466227 DOI: 10.1080/08820538.2024.2323113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To investigate the occurrence of chorioretinopathy post-COVID-19, emphasizing demographic characteristics, medication history, clinical presentation, diagnostic evaluation, and treatment approaches, with a specific focus on the role of corticosteroid use. METHODS Our protocol was registered prospectively on PROSPERO (CRD42023457712). A systematic search of databases (PubMed, Cochrane, WOS, Scopus) from November 2020 to August 2023 were performed to identify any original research reporting chorioretinopathy in COVID-19 patients. Data extraction included patient demographics, COVID-19 timeline, medication history, symptoms, diagnostic tests, and treatment outcomes. We used Joanna Briggs Institute (JBI) critical appraisal tool to assess the quality of our included studies. RESULTS We identified seven case reports and two case series including 10 patients, six females and four males (mean age 36.5 years), who exhibited chorioretinopathy after COVID-19. Onset varied from 6 days to three months post-infection (average = 24.3 days). Seven patients (70%) had a history of corticosteroid use during COVID-19 treatment. Symptoms included visual loss, blurred vision, and deterioration. Diagnostic assessments revealed central serous chorioretinopathy in seven patients (70%) and punctate inner choroidopathy in two (20%). Treatment approaches varied, with corticosteroid discontinuation leading to symptom improvement, while two patients were treated with corticosteroids. Five patients who discontinued corticosteroids were reported to have improvement in visual acuity, two of them changed to 20/25 after being 20/40, two changed to 6/6, and one changed to 20/20, while the visual acuity in the sixth patient was not reported. Regarding the two patients who were treated with corticosteroids, visual acuity was reported in one case only and it improved to 20/20. CONCLUSION This systematic review states the prevalence and potential association between chorioretinopathy, and corticosteroid use in the context of COVID-19. This relation is still unclear because of the relief of symptoms in some cases after corticosteroid discontinuation, while two other cases were treated with corticosteroids and their symptoms improved.
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Affiliation(s)
| | - Mostafa Hossam El Din Moawad
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman E Labeeb
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Elneny
- Damietta Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Zaheer N, Tallouzi MO, Kumar NA, Sreekantam S. Outer Retinopathies Associated with COVID-19 Infection: Case Reports and Review of Literature. Case Rep Ophthalmol Med 2024; 2024:7227086. [PMID: 38495090 PMCID: PMC10942824 DOI: 10.1155/2024/7227086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 03/19/2024] Open
Abstract
Background The coronavirus disease (COVID-19) is a highly contagious disease with profound health implications. It can affect any part of the body with variable severity. Various ophthalmic manifestations of coronavirus disease have been documented. Case Presentations. We reported three cases of outer retinopathies associated with COVID-19 infection. All three patients were young females. The first two patients presented within days of COVID-19 infection with complaints of black spots in the eyes. Multimodal retinal imaging showed lesions consistent with acute macular neuroretinopathy. Lesions were bilateral in the first patient and unilateral in the second one. Our third patient presented with blurred vision in one eye, 3 months after a suspected COVID-19 infection. Retinal imaging showed outer retinopathy. Our patients' vision was good and maintained during the follow-up. All three were monitored on observation only, and symptoms and lesions improved with time. Conclusion In conclusion, COVID-19-related thromboinflammatory response can result in localized vascular inflammation and hypoperfusion in any of the retinal capillary plexuses or choriocapillaris resulting in ischemia of the corresponding retinal or choroidal layers.
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Affiliation(s)
- Naima Zaheer
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
| | - Mohammad O. Tallouzi
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N. Ajith Kumar
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
| | - Sreekanth Sreekantam
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
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3
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Samanta R, Jayaraj S, Mittal SK, Kumari J, Naharwal A, Agrawal A. Post-COVID-19 endogenous endophthalmitis case series and review of literature. Indian J Ophthalmol 2023; 71:3677-3683. [PMID: 37991303 PMCID: PMC10788740 DOI: 10.4103/ijo.ijo_3079_22] [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: 11/22/2022] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To describe a series of post-coronavirus disease 2019 (COVID-19) endogenous endophthalmitis (EE) patients from a multispecialty tertiary hospital in North India. METHODS A retrospective chart review including all consecutive cases with EE following confirmed COVID-19 disease from July 2020 to June 2021. RESULTS Seven eyes of four patients (three female and one male) were included. Two patients had confirmed bilateral fungal (Aspergillus sp.) EE and two patients had presumed fungal EE (one bilateral and one unilateral). Three of these four patients received systemic steroids as part of COVID-19 treatment previously. Five eyes were managed with initial intravitreal injection (IVI), followed by pars plana vitrectomy (PPV), and two eyes were managed with only IVI. All patients received systemic antifungal agents. Intraocular inflammation resolved in all eyes with treatment. One patient of EE also developed voriconazole-induced transient visual hallucination, which resolved on discontinuing the medication. CONCLUSION This case series represents a series of EE cases following COVID-19 disease or its sequelae or as a result of prior treatment for COVID-19. Ophthalmologists and physicians must be vigilant about these complications and initiate prompt management at the earliest.
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Affiliation(s)
- Ramanuj Samanta
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Sreeram Jayaraj
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Sanjeev K Mittal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Jyoti Kumari
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Aarshi Naharwal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ajai Agrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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4
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Angelidis CD, Georgalas I, Giachos I, Symeonidis C, Mani A, Rotsos T. A 30-Year-Old Man with a Recent History of COVID-19 Requiring Treatment with Corticosteroids Who Developed Bilateral Central Serous Chorioretinopathy During 7-Month Follow-Up. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940241. [PMID: 38007612 PMCID: PMC10687741 DOI: 10.12659/ajcr.940241] [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: 03/06/2023] [Revised: 10/24/2023] [Accepted: 08/23/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Central serous chorioretinopathy (CSCR) involves a localized serous macular detachment, secondary to retinal pigment epithelial and choroidal vascular changes, which can be an adverse effect of corticosteroid use. Most CSCR cases resolve spontaneously, and normal vision returns, while some chronic cases can result in blindness. This report is of a 30-year-old man with a recent history of Corona virus disease (COVID)-19 requiring corticosteroid treatment who developed bilateral CSCR with unilateral fibrin and a 7-month follow-up. CASE REPORT A 30-year-old male patient presented with malaise and high fever. The patient tested positive for COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus and was admitted. During hospitalization, he received intravenous (IV) corticosteroids for 1 week (6 mg dexamethasone IV once daily). Following hospitalization, the patient received per os methylprednisolone 16 mg (16 mg once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days). One month later, the patient presented with bilateral visual acuity (VA) deterioration and acute CSCR. The diagnosis and follow-up were performed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). The patient was followed-up for a period of 7 months, during which, although the VA improved and remained stable, the OCT findings were changing. CONCLUSIONS This report highlights the importance of timely ophthalmological examination in patients with sudden vision loss and identification of the association between corticosteroid use and CSCR, as well as the importance of a longer follow-up period.
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Affiliation(s)
| | - Ilias Georgalas
- 1 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Giachos
- 1 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Aikaterini Mani
- 1 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Tryfon Rotsos
- 1 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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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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Khalayli N, Haider G, Hodifa Y, Kudsi M, Naman N. Ocular manifestations in COVID-19 infections: a case series. Ann Med Surg (Lond) 2023; 85:5309-5313. [PMID: 37915673 PMCID: PMC10617833 DOI: 10.1097/ms9.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction The prevalence of ocular abnormalities of COVID-19 is different according to different reports. However, currently available evidence on the presence of this virus in ocular secretions and its association with conjunctivitis is not well established. Objective To reveal the ocular features among COVID-19 patients and to describe them with the findings of clinical data, inflammatory markers, and respiratory support therapy. Methods Ocular symptoms were evaluated and recorded in 494 COV19 patients through questionnaire-style interviews, and an ophthalmologic examination. Data including age, sex, disease severity, and nasopharyngeal swab results were collected. Laboratory test values were reviewed. Patients with COVID-19 infections were classified into severe cases and mild cases. Results The prevalence of ocular features was (2.83%). The most common features were conjunctival hyperaemia, epiphora, and foreign body sensation with itching. Patients with ocular manifestations on CPAP support therapy had higher rates of itching, lower rates of foreign body sensation. No differences were found in the levels of inflammatory marker. Meanwhile, patients used respiratory-aid therapy revealed higher values of white blood cells, platelet counts, erythrocyte sedimentation rate, C-reactive protein, ferritin, and lactate dehydrogenase. Discussion Ocular involvement in COVID-19 and possibility of disease transmission through ocular tissues and secretions, has been registered in some reports, with a prevalence of 2-32%. The external and internal ocular parts are involved. Conclusion Ocular features are not infrequent in COVID-19 patients.
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Affiliation(s)
| | | | | | | | - Nada Naman
- DIS in Ophthalmology, Director of Sham Medical Complex, Damascus, Syrian Arab Republic
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7
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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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Sadeghi E, Mahmoudzadeh R, Garg SJ, Nowroozzadeh MH. Ocular posterior segment complications following COVID-19 vaccination. Int Ophthalmol 2023; 43:4343-4357. [PMID: 37432598 DOI: 10.1007/s10792-023-02795-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has had a significant impact on healthcare, including eye care, worldwide. Effective and safe vaccines have been developed using both conventional and novel technologies to combat SARS-CoV-2 infection. While vaccination has been shown to be remarkably effective in reducing the spread and associated morbidity and mortality of COVID-19 disease, there have been reports of complications to the posterior segment of the eye. METHODS We present a case-based analysis of reported complications of COVID-19 vaccination to the posterior segment of the eye. The study aims to highlight the diversity of possible complications and discuss the plausible involved pathophysiologic mechanisms. RESULTS The most significant complications reported were retinal macro or microvascular occlusions, uveitis, and central serous chorioretinopathy. These complications are rare but require prompt diagnosis and management to prevent serious visual morbidity. CONCLUSIONS Our study highlights the need for ophthalmologists to be aware of possible complications related to COVID-19 vaccination and the importance of prompt diagnosis and management. The findings of this study may help ophthalmologists to better understand and manage these rare complications.
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Affiliation(s)
- Elham Sadeghi
- Department of Ophthalmology, Shiraz University of Medical Sciences, Poostchi Clinic, Zand Street, Shiraz, 7134997446, Iran
| | - Raziyeh Mahmoudzadeh
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sunir J Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Hossein Nowroozzadeh
- Department of Ophthalmology, Shiraz University of Medical Sciences, Poostchi Clinic, Zand Street, Shiraz, 7134997446, Iran.
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Castro CS, Ferreira AS, Silva NP, Lume MR, Furtado MJ. PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER COVID-19: MULTIMODAL EVALUATION. Retin Cases Brief Rep 2023; 17:791-796. [PMID: 35858279 DOI: 10.1097/icb.0000000000001301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To report the case and multimodal imaging findings of a healthy young woman who developed paracentral acute middle maculopathy 9 weeks after COVID-19. METHODS Case report. Ultra-widefield fundus photography, macular spectral domain optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography were performed. RESULTS A 36-year-old woman went to the emergency department with sudden, painless, left eye vision loss. The only relevant medical history was COVID-19 9 weeks before. The best-corrected visual acuity was 20/200, a left eye relative afferent pupillary defect was present, and superficial hemorrhages throughout the macular area and peripheral retina were found. Nearly 4 hours after admission, the left eye best-corrected visual acuity recovered to 20/20 without relative afferent pupillary defect. Five days after presentation in the emergency department, the patient returned with recurrent left eye vision loss, with spontaneous recovery within 12 hours. Macular spectral domain optical coherence tomography revealed hyperreflectivity of the inner plexiform and inner nuclear layers, and the diagnosis of paracentral acute middle maculopathy was established. The patient started oral acetylsalicylic acid and oral prednisolone. The patient did not report any new episodes of vision loss, and there was a progressive resolution of abnormal fundus findings. CONCLUSION SARS-CoV-2 infection increases the risk of vascular thrombotic events with possible involvement of the retinal circulation, and paracentral acute middle maculopathy may present as a possible complication. Ophthalmologists should be able to recognize it promptly through multimodal imaging findings.
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Affiliation(s)
- Catarina S Castro
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - André S Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal; and
| | - Nisa P Silva
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel R Lume
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria J Furtado
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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10
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Xie CA, Singh J, Tyagi M, Androudi S, Dave VP, Arora A, Gupta V, Agrawal R, Mi H, Sen A. Endogenous Endophthalmitis - A Major Review. Ocul Immunol Inflamm 2023; 31:1362-1385. [PMID: 36306406 DOI: 10.1080/09273948.2022.2126863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 10/31/2022]
Abstract
Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the rise. Common ocular signs and symptoms associated with EE include conjunctival injection, ocular pain, and reduced visual acuity. On clinical examination, a history of prior or coexisting systemic infections, symptoms (e.g., fever, malaise), and localizing features may be noted. Clinical diagnosis is often challenging, resulting in critical delays that contribute to a poor prognosis. Blood cultures and ocular fluid samples can aid in conforming causative pathogen(s), after which empirical antibiotic therapy, both systemic and intravitreal, should be instated. The use of steroids to suppress inflammation remains controversial. Surgical options include pars plana vitrectomy. Overall prognosis varies depending on host and pathogen factors, and early diagnosis and initiation of appropriate treatment are crucial.
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Affiliation(s)
- Cen Amy Xie
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jayanti Singh
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
| | - Mudit Tyagi
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Vivek Pravin Dave
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Atul Arora
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Eye ACP programme, Duke NUS Medical School, Singapore
- Ocular Infections and AntiMicrobials Group, Singapore Eye Research Institute, Singapore
| | - Helen Mi
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Alok Sen
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
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11
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Premi E, Acampora R, Salmi D, Ilie IA, Pagnoncelli N, Germano F, Gandolfi G, Sanicas M, Seed A, Michael BD, Donati S, Azzolini C, Lanfranchi F. Clinical and Diagnostic Findings of Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy in the COVID-19 Era. Ophthalmologica 2023; 246:181-191. [PMID: 37573773 PMCID: PMC10614461 DOI: 10.1159/000533530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Growing evidence suggests an association between the infection from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and eye disorders. The aim of this review was to analyze the clinical presentation and diagnostic features of acute macular neuroretinopathy (AMN) and paracentral acute middle maculopathy (PAMM) associated with COVID-19 infection. The features are then compared with previous reports regarding these retinal disorders, to recognize possible specific characteristics and to assess the role of multimodal ophthalmic imaging. SUMMARY A literature search was performed by consulting PubMed, Scopus, and Embase. The following terms were searched: "(COVID-19 OR SARS-CoV-2 OR coronavirus) AND ([acute macular neuroretinopathy] OR [paracentral acute middle maculopathy])." Inclusion criteria were as follows: (1) publication date from January 31, 2020 to January 31, 2022; (2) English language; (3) original research or case report; (4) free full-text availability.Optical coherence tomography (OCT) findings in AMN patients were hyper-reflectivity (HR) of the outer plexiform layer, of the outer nuclear layer, and ellipsoid or interdigitation zones (EZ and IZ, respectively) disruption. In most cases, the presence of HR and EZ/IZ abnormalities resulted combined. When performed, OCT angiography (OCTA) identified attenuation of signal of the deep capillary plexus (DCP). The most common OCT finding in PAMM was an alteration of the inner nuclear layer, associated with other areas of HR, while no signs of EZ/IZ disruption were detected. When performed, OCTA showed the attenuation of signal of both the DCP and the superficial capillary plexus. KEY MESSAGES In this review, we reported a case series of AMN and PAMM in patients with a previous or concomitant infection from SARS-CoV-2. The microvascular changes in these cases are highlighted by the OCTA scans. Even if we are far from the determination of a direct link between COVID-19 and these retinal disorders, we could hypothesize that the vascular alterations associated with SARS-CoV-2 infection could be a possible risk factor for both AMN and PAMM.
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Affiliation(s)
- Elias Premi
- Ophthalmology Unit, ASST Sette Laghi, Circolo Hospital and Macchi Foundation, Varese, Italy
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Roberto Acampora
- Milan Center for Neuroscience (NeuroMI), Milan, Italy
- Neurology and Stroke-Unit, Hospital Ospedale del Mare, Naples, Italy
| | - Davide Salmi
- Anesthesia and Intensive Care Unit, Biotechnology and Life Sciences Department, University of Insubria, Varese, Italy
| | - Ingrid Andrea Ilie
- Department of Life Sciences and Biotechnology, School of Biology, University of Ferrara, Ferrara, Italy
| | - Nadia Pagnoncelli
- Psychiatry Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Germano
- Neurology Unit, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Greta Gandolfi
- Anesthesia and Intensive Care Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Melvin Sanicas
- Clinical – Vaccines, Clover Biopharmaceuticals, Zurich, Switzerland
| | - Adam Seed
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
- The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
| | - Benedict Daniel Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
- The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
| | - Simone Donati
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Claudio Azzolini
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesco Lanfranchi
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
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12
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Chaudhary S, Sitaula RK, Karki P, Joshi SN. Endogenous endophthalmitis in post-COVID-19 patients: a case report. Ann Med Surg (Lond) 2023; 85:4137-4141. [PMID: 37554872 PMCID: PMC10406071 DOI: 10.1097/ms9.0000000000001051] [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: 03/15/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Ocular involvement in coronavirus disease 2019 (COVID-19) can be due to direct viral invasion or indirectly due to an immunosuppressed state. Prolonged hospitalization also makes them susceptible to various secondary infections. The purpose of this case report is to report two rare cases of endogenous endophthalmitis (EE) in COVID-19 recovered patients. CASE PRESENTATION Two patients who were hospitalized and received treatment for COVID-19 pneumonia with remdesivir and systemic steroids presented with decreased vision. The first case had a severe anterior chamber reaction with a hypopyon and dense exudates in the vitreous. The second case had cells and flare in the anterior chamber and exudates in the vitreous. They were diagnosed with EE and underwent a diagnostic vitreous tap followed by pars plana vitrectomy and intravitreal antibiotic and steroid. The culture of vitreous fluid was negative for any bacteria and fungus in both cases. However, the first case demonstrated Escherichia coli in urine culture. The follow-up visual acuity was no perception of light and only perception of light in the first and second case, respectively. CLINICAL DISCUSSION Severe COVID-19 patients who are hospitalized, receive systemic steroid and have associated comorbidities like diabetes mellitus are at high risk of EE. CONCLUSION Delay in diagnosis and appropriate treatment in these patients leads to poor visual outcome.
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Affiliation(s)
- Santosh Chaudhary
- Department of Ophthalmology, B.P. Koirala Institute of Health Sciences, Dharan
| | - Ranju K. Sitaula
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pratap Karki
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sagun N. Joshi
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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13
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Yeo S, Kim H, Lee J, Yi J, Chung YR. Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1793-1808. [PMID: 36598554 PMCID: PMC9811047 DOI: 10.1007/s00417-022-05953-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Abnormal hypercoagulability and increased thromboembolic risk are common in patients with coronavirus disease (COVID-19). COVID-19 has been suggested to cause retinal vascular damage, with several studies on COVID-19 patients with retinal vascular occlusions. We reviewed and investigated studies on retinal vascular occlusions in patients diagnosed with COVID-19 and in those vaccinated for COVID-19. METHODS Studies that reported retinal vascular occlusion in COVID-19 patients or in vaccinated people were identified using the terms "retinal occlusion," together with "severe acute respiratory syndrome coronavirus 2", "SARS-CoV-2," "COVID-19," "coronavirus," and "vaccine," through systematic searches of PubMed and Google Scholar databases until January 7, 2022. RESULTS Thirteen cases of retinal artery occlusion (RAO) and 14 cases of retinal vein occlusion (RVO) were identified among patients diagnosed with COVID-19. Half of the patients with RAO or RVO revealed no systemic disorders except current or past COVID-19, and ocular symptoms were the initial presentation in five cases. Among patients with RAO, most presented with central RAO at 1-14 days of COVID-19 diagnosis, with abnormal coagulation and inflammatory markers. Among those with RVO, two-thirds presented with central RVO and one-third with RVO. Eleven cases with acute macular neuroretinopathy (AMN) and/or paracentral acute middle maculopathy (PAMM) were reported among patients with COVID-19, presenting scotoma resolved spontaneously in most cases. Among the 26 cases vaccinated with either mRNA or adenoviral vector vaccines for COVID-19 and presenting retinal vascular occlusions, there were more RVO cases than RAO cases, and ocular symptoms mostly occurred within 3 weeks after vaccination. One case presented bilateral AMN and PAMM after COVID-19 vaccination. CONCLUSION Retinal vascular occlusions might be a manifestation of COVID-19, although rare, especially in patients at risk of systemic hypercoagulability and thromboembolism. For COVID-19 vaccines, the causal relationship is controversial because there are few case reports of retinal vascular occlusions after COVID-19 vaccination.
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Affiliation(s)
- Suji Yeo
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Korea
| | - Hanju Kim
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Jiwon Lee
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Jeonghyun Yi
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Korea.
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14
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Dutta Majumder P, Agarwal A. Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy during SARS-CoV-2 Infection and Vaccination. Vaccines (Basel) 2023; 11:vaccines11020474. [PMID: 36851351 PMCID: PMC9962518 DOI: 10.3390/vaccines11020474] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
Purpose: To review the demographic and clinical profile of patients developing acute macular neuroretinopathy (AMN) or paracentral acute middle maculopathy (PAMM) after receiving coronavirus disease-2019 (COVID-19) vaccination or infection. Methods: In this review article, the published literature was searched to determine cases developing either AMN or PAMM after COVID-19 vaccinations or infections. Data, including demographic profile, presenting features, symptoms, diagnosis, and clinical outcomes, were extracted from the selected publications. These parameters were compared between the two groups, i.e., patients developing AMN/PAMM either after vaccination or infection. Results: After the literature review, 57 patients developing either AMN (n = 40), PAMM (n = 14), or both (n = 3) after COVID-19 infection (n = 29) or vaccination (n = 28) were included (mean age: 34.9 ± 14.4 years; n = 38; 66.7% females). In 24.6% patients, the diagnosis of COVID-19 infection was preceded by the development of ocular disease. There were no significant differences in the age or gender between the patients developing AMN or PAMM after vaccination or infection (p > 0.13). Among the vaccination group, the highest number of patients developing AMN/PAMM were after the Oxford-AstraZeneca (n = 12; 42.9%). Patients with vaccination had a significantly early onset of AMN/PAMM compared to those with infection (11.5 ± 17.6 days versus 37.8 ± 43.6 days; p = 0.001). Conclusions: Both AMN and PAMM are reported to be associated with COVID-19 infections and in persons receiving vaccination against COVID-19. While COVID-19 infections and vaccinations may have a contributory role, other risk factors such as oral contraceptive pills may also play a role in the development of the disease.
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Affiliation(s)
- Parthopratim Dutta Majumder
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai 600006, India
- Correspondence: ; Tel.: +91-44-2827-1616
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi P.O. Box 112412, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Department of Ophthalmology, Maastricht University Medical Center, 6211 LK Maastricht, The Netherlands
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15
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Fekri S, Khorshidifar M, Esfahanian F, Veisi A, Nouri H, Abtahi SH. Endogenous Fungal Endophthalmitis following COVID-19 Hospitalization: Evidence from a Year-Long Observational Study. J Fr Ophtalmol 2023; 46:461-467. [PMID: 36890074 PMCID: PMC9933852 DOI: 10.1016/j.jfo.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE To describe cases of endogenous fungal endophthalmitis (EFE) post-recovery from or hospitalization for coronavirus disease 2019 (COVID-19). METHODS This prospective audit involved patients with suspected endophthalmitis referred to a tertiary eye care center over a one-year period. Comprehensive ocular examinations, laboratory studies, and imaging were performed. Confirmed cases of EFE with a recent history of COVID-19 hospitalization±intensive care unit admission were identified, documented, managed, followed up, and described. RESULTS Seven eyes of six patients were reported; 5/6 were male, and the mean age was 55. The mean duration of hospitalization for COVID-19 was approximately 28 days (14-45); the mean time from discharge to onset of visual symptoms was 22 days (0-35). All patients had underlying conditions (5/6 hypertension; 3/6 diabetes mellitus; 2/6 asthma) and had received dexamethasone and remdesivir during their COVID-related hospitalization. All presented with decreased vision, and 4/6 complained of floaters. Baseline visual acuity ranged from light perception (LP) to counting fingers (CF). The fundus was not visible in 3 out of 7 eyes; the other 4 had "creamy-white fluffy lesions" at the posterior pole as well as significant vitritis. Vitreous taps were positive for Candida species in six and Aspergillus species in one eye. Anti-fungal treatment included intravenous amphotericin B followed by oral voriconazole and intravitreal amphotericin B. Three eyes underwent vitrectomy; the systemic health of two patients precluded surgery. One patient (with aspergillosis) died; the others were followed for 7-10 months - the final visual outcome improved from CF to 20/200-20/50 in 4 eyes and worsened (hand motion to LP) or did not change (LP), in two others. CONCLUSION Ophthalmologists should maintain a high index of clinical suspicion for EFE in cases with visual symptoms and a history of recent COVID-19 hospitalization and/or systemic corticosteroid use - even without other well-known risk factors.
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Affiliation(s)
- S Fekri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Khorshidifar
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Esfahanian
- School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Ave., Isfahan, Iran.
| | - A Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Ave., Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran.
| | - S-H Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Parachuri N, Prabhushanker M, Geetha G, Bagrecha N. Post-COVID ischemic maculopathy – A case report. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2023. [DOI: 10.4103/jcor.jcor_95_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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17
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Ramamurthy S, Joseph J, Dave VP. Candida Albicans Sub-Retinal Abscess following COVID-19. Indian J Ophthalmol 2022; 70:3707-3709. [PMID: 36190078 PMCID: PMC9789817 DOI: 10.4103/ijo.ijo_1363_22] [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] [Indexed: 11/05/2022] Open
Abstract
A 42-year-old male post-renal transplantation presented with sudden diminution of vision in the left eye. The right eye was lost following a failed vitreoretinal surgery 5 years ago. The patient had been hospitalized 4 months prior for coronavirus disease 2019 infection with a good recovery. The presenting visual acuity was 20/600 in the right eye and 20/250 in the left eye. Fundus examination revealed a sub-macular sub-retinal abscess in the left eye. Sub-retinal aspiration of the abscess revealed Candida albicans. The patient was managed with repeated intravitreal amphotericin B injections, following which the abscess resolved with scarring and vision improving to 20/60.
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Affiliation(s)
- Srishti Ramamurthy
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Insitute, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India,Correspondence to: Dr. Srishti Ramamurthy, Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Insitute, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India. E-mail:
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Insitute, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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18
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Abrishami M, Daneshvar R, Emamverdian Z, Saeedian N, Tohidinezhad F, Eslami S, Ansari-Astaneh MR. Spectral-domain optical coherence tomography assessment of retinal and choroidal changes in patients with coronavirus disease 2019: a case-control study. J Ophthalmic Inflamm Infect 2022; 12:18. [PMID: 35716213 PMCID: PMC9206085 DOI: 10.1186/s12348-022-00297-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives This study aimed to evaluate the retinal and choroidal changes in the macular region of patients with Coronavirus Disease 2019 (COVID-19) using structural spectral-domain optical coherence tomography (SD-OCT) analysis. Methods This cross-sectional observational case-control study included patients recovered from COVID-19. The COVID-19 in all participants was confirmed using the reverse transcription-polymerase chain reaction (RT-PCR) technique. The participants had mild to moderate degree of disease without a history of hospitalization, steroid usage, or blood saturation below 92%. Macular SD-OCT was performed at least two weeks and up to one month after recovery from systemic COVID-19. Quantitative and qualitative changes detected by macular SD-OCT imaging were evaluated in COVID-19 recovered patients and compared with the results of age-matched normal controls. Results Participants in this study included 30 cases (60 eyes) and 60 healthy controls (120 eyes). In total, 17 (28.3%) eyes in patient group showed at least one abnormal finding indicated by macular SD-OCT imaging included hyperreflective lesions in different retinal layers. In addition, dilated choroidal vessels and retinal pigment epitheliopathy were evident in 41 (68.3.6%) and 4 (6.6%) eyes in patient group, respectively, and their OCT findings resembled those with pachychoroid spectrum. No statistically significant differences were observed in retinal layers or retinal volume between the two groups. The mean ± SD subfoveal choroidal thickness (SFCT) was determined at 380.3 ± 12.40 μm, which was significantly thicker than that in control group (310.7 ± 57.5 μm) (P < 0.001). Conclusion Regarding retinal thickness, no significant change was observed in different retina layers of patients with COVID-19; however, there were striking qualitative changes, such as hyperreflective lesions in different retinal layers. The evaluation of choroidal structure and thickness demonstrated remarkable abnormal pachyvessels and significant thickening of the SFCT but the clinical significance of these findings is unknown.
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Affiliation(s)
- Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Daneshvar
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Emamverdian
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Saeedian
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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19
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Wang S, Wang J, Hu J, Wang N. Retinal microvascular impairment in COVID-19 patients: A meta-analysis. Immun Inflamm Dis 2022; 10:e619. [PMID: 35634955 PMCID: PMC9091999 DOI: 10.1002/iid3.619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has led to a global pandemic in an unprecedented time frame. Systemic vascular involvement in COVID‐19 has been identified, and SARS‐CoV‐2 has also been found to cause multiple organ ischemia and posterior ocular segment disease in mammals, raising concerns about the human retinal microvascular involvement in SARS‐CoV‐2. Objective To objectively assess the presence of retinal microvascular impairment in COVID‐19 patients by optical coherence tomography angiography (OCTA), so as to facilitate the clinical system management of COVID‐19 patients. Methods We searched PubMed, Cochrane Library, EMBASE, Ovid, CBM to collect eligible studies. The main outcomes included the vessel density (VD), area or perimeter of foveal avascular zone (FAZ), central foveal thickness (CFT), subfoveal choroidal thickness (SCT) in our meta‐analysis. Results We eventually included five studies with a total of 401 participants. Our meta‐analysis showed that nonacute infectious COVID‐19 or post‐COVID‐19 patients presented significantly lower foveal VD of deep capillary plexus (WMD = −4.22, 95% CI [−8.00, −0.43]) and thinner SCT (WMD = −10.33, 95% CI [−19.08, −1.57]) than healthy controls. The foveal VD and parafoveal VD of superficial capillary plexus, parafoveal VD of deep capillary plexus, CFT, area, and perimeter of FAZ showed no significant differences between the groups. Conclusion The patients of nonacute infectious COVID‐19 or post‐COVID‐19 displayed alterations in the retinal microvasculature and choroidal vessels, including a significantly lower foveal VD in deep capillary plexus and thinner SCT. The impairment may be a medium to long‐term process. Close ophthalmic surveillance is necessary for COVID‐19 patients or post‐COVID‐19 patients.
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Affiliation(s)
- Suzhen Wang
- Eye School Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Wang
- Aier Eye Hospital (East of Chengdu), Chengdu, China
| | - Jianbin Hu
- Aier Eye Hospital (East of Chengdu), Chengdu, China
| | - Ningli Wang
- Eye School Chengdu University of Traditional Chinese Medicine, Chengdu, China
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20
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Deepa MJ, Megharaj C, Patil S, Rani PK. Cryptococcus laurentii endogenous endophthalmitis post COVID-19 infection. BMJ Case Rep 2022; 15:15/5/e246637. [PMID: 35545307 PMCID: PMC9096502 DOI: 10.1136/bcr-2021-246637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A man in mid-50s presented with progressive blurred vision in his left eye for over 6 weeks. He was a known diabetic with history of COVID-19 pneumonia treated with steroids and remdesivir. He had pyelonephritis and urinary culture grown Klebsiella. He was referred as a case of non-resolving vitreous haemorrhage. Visual acuity (VA) was hand movements with fundus showing dense vitritis. He underwent pars plana vitrectomy, vitreous biopsy with intraocular antibiotics (imipenem) suspecting as a case of endogenous bacterial endophthalmitis. Vitreous biopsy did not yield organisms on the smear/culture. The patient’s condition worsened with perception of light and fundus showing dense vitritis with discrete yellowish white deposits on the surface of the retina. A repeat vitreous biopsy done along with intravitreal injection of voriconazole (suspecting fungal aetiology) grown fungal colonies and the organism was identified as Cryptococcus laurentii. At 4-month follow-up, the VA improved to 6/24.
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Affiliation(s)
| | - Chitta Megharaj
- Cataract and Refractive Services, Adarsh Super Speciality Eye Hospital, Shimoga, India
| | - Santosh Patil
- Microbiology, Nanjappa Super Speciality Hospital, Shimoga, Karnataka, India
| | - Padmaja Kumari Rani
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
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21
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Hanhart J, Roditi E, Wasser LM, Barhoum W, Zadok D, Brosh K. Central serous chorioretinopathy following the BNT162b2 mRNA vaccine. J Fr Ophtalmol 2022; 45:597-602. [PMID: 35577701 PMCID: PMC9099405 DOI: 10.1016/j.jfo.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
Abstract
Background and purpose Methods Results Conclusions
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Affiliation(s)
- J Hanhart
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel.
| | - E Roditi
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - L M Wasser
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - W Barhoum
- Carmel Medical Center, Haifa, Israel
| | - D Zadok
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - K Brosh
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
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22
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Sheth J, Nayak S, Narayanan R, Hariprasad S. Retinal Manifestations of COVID-19. Ophthalmic Surg Lasers Imaging Retina 2022; 53:246-248. [PMID: 35575740 DOI: 10.3928/23258160-20220413-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Al-Namaeh M. Ocular manifestations of COVID-19. Ther Adv Ophthalmol 2022; 14:25158414221083374. [PMID: 35434520 PMCID: PMC9008819 DOI: 10.1177/25158414221083374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19 is a disease caused by a SARS-CoV-2 viral infection, a disease that was
first detected in December 2019 in Wuhan, Hubei Province, China. COVID-19,
formerly known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease, was
officially named COVID-19 by the World Health Organization (WHO) in February
2020. By 25 May 2021, there were 33,579,116 confirmed cases with 599,109
COVID-19 deaths worldwide. The purpose of this review article is to provide an
update on what is currently known about COVID-19 ocular symptoms in adults, the
elderly, and children in the literature. Finally, this article will review the
eye protection precautions that should be implemented in our clinics. To assess
the current literature, PubMed was searched from December 2019 to 25 May 2021.
Randomized trials, observational studies, case series or case reports, letters
of research, and letters to editors were selected for confirmed cases of
COVID-19. According to current scientific literature since the outbreak in
December 2019, 205 articles have been published. Conjunctivitis, conjunctival
hyperemia, and chemosis have been reported in adults with COVID-19. There have
been few studies on children and elderly patients, and further research in these
age groups is needed. Finally, wearing eye protection when seeing patients on a
daily basis during the pandemic is essential.
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Affiliation(s)
- Mashael Al-Namaeh
- Eye Research Center, LLC, 4023 Kennett Pike # 548, Wilmington, DE 19807, USA
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Dutta Majumder P. Endogenous fungal endophthalmitis in COVID-19 patients: An unexplored possibility. Indian J Ophthalmol 2022; 70:1083-1085. [PMID: 35325989 PMCID: PMC9240571 DOI: 10.4103/ijo.ijo_510_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sharifi A, Daneshtalab A, Zand A. Bilateral Central Serous Chorioretinopathy After Treatment of COVID-19 Infection. Cureus 2022; 14:e23446. [PMID: 35494916 PMCID: PMC9038508 DOI: 10.7759/cureus.23446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Abstract
We report a rare case of bilateral central serous chorioretinopathy (CSCR) after COVID-19 management with steroids. The patient was a 49-year-old female who presented with bilateral blurred vision three months after the COVID-19 infection. She had been treated with intravenous Remdesivir and Dexamethasone. After her recovery from the disease, she developed gradual visual impairment in both her eyes. Upon examinations and optical coherence tomography, bilateral CSCR was revealed. She was treated with eplerenone (25 mg/day) and propranolol (20 mg/day), and the symptoms were improved after two months. Post-COVID-19 associated CSCR can occur due to steroids administration. Therefore, patients and physicians should be aware of these possible complications and seek an ophthalmology consultation as early as possible.
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Mohd-Alif WM, Nur-Athirah A, Hanapi MS, Tuan Jaffar TN, Shatriah I. Bilateral and Multiple Central Serous Chorioretinopathy Following COVID-19 Infection: A Case Report and Literature Review. Cureus 2022; 14:e23246. [PMID: 35449667 PMCID: PMC9012563 DOI: 10.7759/cureus.23246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 12/15/2022] Open
Abstract
Central serous chorioretinopathy (CSCR) following coronavirus disease 2019 (COVID-19) infection is rare. We describe an adult patient who survived a COVID-19 infection and received intravenous and oral corticosteroid treatment for three weeks. He presented three weeks post COVID-19 infection with central visual loss in both eyes for six days. Fundus examination showed multiple localized serous retinal detachments in both eyes. Optical coherence tomography (OCT) of the macula confirmed the presence of multiple areas of serous retinal detachment and pigment epithelial detachment. The patient was treated with topical non-steroidal anti-inflammatory eye drops and regained full visual recovery after three months. Corticosteroid treatment for COVID-19 and psychological stress induced by the disease are potential risk factors for the development of CSCR. Physicians should be aware of this side effect, as an early referral to an ophthalmologist for treatment is essential.
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Invernizzi A. The impact of COVID-19 on the retina: clinical features and management considerations. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2021877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
- The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, Sydney Eye Hospital, The University of Sydney, Sydney, Australia
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Sanjay S, Agrawal S, Jayadev C, Kawali A, Gowda PB, Shetty R, Mahendradas P. Posterior segment manifestations and imaging features post-COVID-19. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2021; 10:95-106. [PMID: 37641707 PMCID: PMC10460223 DOI: 10.51329/mehdiophthal1427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/19/2021] [Indexed: 08/31/2023]
Abstract
Background To report the posterior segment (uvea and retinal) manifestations and imaging characteristics of eyes of patients with and after coronavirus disease 2019 (COVID-19). Methods We searched the PubMed/MEDLINE database to identify relevant articles using the following search terms: COVID-19, SARS-CoV-2, retina, uvea, optic nerve, retinal findings, posterior segment manifestations, and endophthalmitis. Articles published from December 1, 2019, to May 30, 2021, and indexed in PubMed/ MEDLINE were screened. Results For the purpose of this review, we included clinical features of 26 case reports and 8 case series. The posterior segment manifestations reported included cotton wool spots, retinal hemorrhages, central serous retinopathy, papillophlebitis, optic neuritis, panuveitis, multifocal retinitis, necrotizing retinitis, central retinal artery/vein occlusion, and Purtschner like retinopathy. In this review, we have also included optical coherence tomography angiography (OCTA) features that have been described in COVID-19 patients with pneumonia. Conclusions COVID-19 patients can experience uveo-retinal manifestations even after recovery. These patients, even if asymptomatic for eye symptoms, should undergo an eye evaluation to rule out posterior segment involvement. OCTA performed in these patients revealed microvascular changes in the superficial and deep retinal plexuses. Some of these patients may require anticoagulant or antiplatelet therapy.
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Affiliation(s)
- Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Sameeksha Agrawal
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
- Department of Retina, Narayana Nethralaya, Bangalore, India
| | | | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | | | - Rohit Shetty
- Department of Neuro-ophthalmology, Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
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[Bilateral central serous chorioretinopathy post-COVID-19]. J Fr Ophtalmol 2021; 44:1484-1490. [PMID: 34756744 PMCID: PMC8520853 DOI: 10.1016/j.jfo.2021.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/11/2022]
Abstract
La maladie à virus corona (COVID-19) peut provoquer de nombreuses manifestations oculaires. Nous rapportons un cas rare de choriorétinopathie séreuse centrale bilatérale, post-infection au COVID-19, chez une femme âgée de 38 ans qui s’est présentée pour un flou visuel bilatéral, 1 mois après l’infection au COVID-19. Elle avait de la fièvre, des frissons, une toux et un essoufflement avec fatigue et elle était positive au COVID-PCR. Pendant son séjour de 10 jours à l’hôpital, elle a reçu une oxygénothérapie, des antibiotiques, de l’héparine et des corticoïdes par voie intraveineuse puis relais par voie orale en ambulatoire. Après sa guérison du COVID-19, la patiente a développé une baisse progressive de l’acuité visuelle des 2 yeux : son acuité visuelle de loin corrigée était de 3/10 dans les 2 yeux, le segment antérieur était normal et le vitré était clair. L’examen du fond d’œil, complété par la tomographie en cohérence optique et l’angiographie à la fluorescéine a montré des décollements séreux rétiniens bilatéraux. L’évolution a été marquée par une amélioration de l’acuité visuelle et une régression des décollements séreux rétiniens. La choriorétinopathie séreuse centrale peut survenir après une infection au COVID-19 en raison de l’administration des corticoïdes et un contrôle ophtalmologique précoce est indispensable pour dépister au plus tôt une atteinte oculaire.
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Au SCL. Comment on: Retinal manifestations in patients following COVID-19 infection. Indian J Ophthalmol 2021; 69:2906-2907. [PMID: 34571685 PMCID: PMC8597449 DOI: 10.4103/ijo.ijo_1929_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
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Goyal M, Murthy SI, Annum S. Response comment on: Retinal manifestations in patients following COVID-19 infection. Indian J Ophthalmol 2021; 69:2907-2908. [PMID: 34571686 PMCID: PMC8597500 DOI: 10.4103/ijo.ijo_2100_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mallika Goyal
- Department of Ophthalmology, Apollo Hospitals, Hyderabad, Telangana, India
| | | | - Sridhar Annum
- Department of Ophthalmology, Apollo Hospitals, Hyderabad, Telangana, India
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Mehta S, Nagvekar V, Gupta G. Utility of 2-Deoxy-2-[18F]fluoro-Dglucose positron emission tomography/computed tomography scan in the systemic evaluation of patients with post-COVID-19 endogenous presumed fungal endophthalmitis. Indian J Ophthalmol 2021; 69:2873-2874. [PMID: 34571657 PMCID: PMC8597434 DOI: 10.4103/ijo.ijo_1784_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Salil Mehta
- Department of Ophthalmology, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Vasant Nagvekar
- Department of Infectious Diseases, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Garima Gupta
- Department of Infectious Diseases, Lilavati Hospital, Mumbai, Maharashtra, India
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Bansal R, Majji AB, Reddy AG, Honavar SG. From hazy dusk till dawn. Indian J Ophthalmol 2021; 69:1657. [PMID: 34146006 PMCID: PMC8374798 DOI: 10.4103/ijo.ijo_1424_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ayyadurai N, Singh SR, Dogra M. Commentary: Retinal manifestations in patients following COVID-19 infection: A consecutive case series. Indian J Ophthalmol 2021; 69:1283. [PMID: 33913877 PMCID: PMC8186597 DOI: 10.4103/ijo.ijo_698_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | - Mohit Dogra
- Advanced Eye Centre, PGIMER, Sector 12, Chandigarh, India
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Sudha V. Original research or research waste? KERALA JOURNAL OF OPHTHALMOLOGY 2021. [DOI: 10.4103/kjo.kjo_110_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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