Waves of COVID-19 Pandemic: Effect on Ocular Surface Services at a Tertiary Eye Center in India.

Objective To describe the impact of lockdown and unlock phases of the coronavirus disease 2019 (COVID-19) pandemic on the ocular surface services at a tertiary eye care center in India. Methods This cross-sectional hospital-based study included 18,127 patients presenting between March 25, 2017, and July 31, 2021. A comparative analysis of the data was performed on the patients diagnosed with ocular surface disorders (allergic eye disease, cicatrizing conjunctivitis, dry eye, limbal stem cell deficiency, and ocular surface burns) and ocular surface surgeries (amniotic membrane grafting, keratoprosthesis, mucous membrane grafting, and simple limbal epithelial transplantation) presenting during the lockdown and unlock phases and the previous three years before COVID-19. Results The outpatient numbers dropped to 18.6% (172/954) and surgeries performed decreased to 2.8% (13/461) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 74% reduction in the proportion of patients requiring inter-state travel to this tertiary care referral center. There was a gradual recovery of the outpatient numbers to 70.8% (565/798) and surgeries performed to 85.8% (109/127) of pre-COVID-19 volumes by February-March 2021. This gradual incremental trend was seen across all diagnoses and surgeries except for ocular burns, which showed an initial spike in the month of May followed by another sharp increase by the month of September that coincided with the gradual ease of lockdown regulations. The proportion of patients requiring inter-state travel showed an incomplete recovery to 77.2% of pre-COVID-19 distribution by March 2021. Conclusion The first year of the COVID-19 pandemic saw a drastic reduction in the outpatient numbers and surgical volume in the lockdown phase, which gradually recovered during the unlock period. However, the impact of the second wave was significant and is showing a gradual recovery in patients accessing eye care services.

Clinical Utility of COVID-19 Real Time-Polymerase Chain Reaction Testing of Ocular Tissues of Non-COVID-19 Cornea Donors Deemed Suitable for Corneal Retrieval and Transplantation.

PURPOSE: The purpose of this study was to evaluate the prevalence of SARS-CoV-2 in human postmortem ocular tissues of asymptomatic donors and its implications on our eye banking protocols. METHODS: The expression of SARS-CoV-2 RNA was assessed by reverse transcription-polymerase chain reaction in corneal rims and conjunctival tissues from 100 donors who were found suitable for transplantation as per the donor screening guidelines of the Global Alliance of Eye Bank Associations. The donor's clinical history and cause of death were assessed for secondary analysis. RESULTS: Of 200 ocular tissues (100 corneal and 100 conjunctival) from the same 1 eye of 100 surgical-intended donors, between September 2020 and April 2021, the overall positivity rate for SARS-CoV-2 was ∼1% (2/200). Both the ocular samples that tested positive were conjunctival biopsies (2/100, 2%), whereas corneal samples were negative (0/100, 0%) in both donors. The causes of donor death were trauma in 51 donors, suicide in 33, cardiac arrest in 7, electric shock in 5, metabolic cause in 2, malignancy in 1, and snake bite in 1. None of the donors had a medical history suggestive of COVID infection or possible contact. None of the recipients from the donors were reported to have any systemic adverse event after keratoplasty until the follow-up of 6 weeks. CONCLUSIONS: The overall prevalence of SARS-CoV-2 was 1% (2% for conjunctival and 0% for corneal samples, P value = 0.5) in the donors who were found suitable for cornea recovery and transplantation. The findings of exceptionally low positive rates in our samples validate the criticality of history-based donor screening and do not support the necessity of postmortem PCR testing as a criterion for procurement and subsequent use for corneal transplantation.

Epidemic Keratoconjunctivitis in India: Trend Analysis and Implications for Viral Outbreaks.

Purpose: To describe the correlation between the temporal pattern of presentation of acute epidemic keratoconjunctivitis (EKC) of presumed adenoviral etiology with meteorological parameters such as environmental temperature, rainfall, humidity, and wind speed. Methods: This cross-sectional hospital-based study included 2,408,819 patients presenting between August 2010 and February 2020. Patients with a clinical diagnosis of EKC in at least one eye were included as cases. A smaller cohort of patients with acute (≤1 week) presentation hailing from the district of Hyderabad during the calendar years 2016-2019 was used to perform correlation analysis with the local environmental temperature, rainfall, humidity, and wind speed (data obtained from the Telangana State Development and Planning Society). Results: Overall, 21,196 (0.87%) patients were diagnosed with EKC, of which 19,203 (90.6%) patients had acute onset; among which the cohort from the district of Hyderabad included 1,635 (8.51%) patients. The mean monthly prevalence in this cohort was 0.89% with a peak prevalence in April (1.09%). The environmental parameters of rainfall (r2 = 0.47/P = 0.0131), humidity (r2 = 0.65/P = 0.0014), and wind speed (r2 = 0.56/P = 0.0047) were significantly negatively correlated with the temporal pattern of EKC in the population. There was no visible trend or significant correlation seen with temperature (r2 = 0.08/P = 0.3793). Conclusion: Contrary to popular belief, epidemic viral infections like EKC may not be affected by temperature, but rather by a complex interplay of other environmental factors such as humidity, rainfall, and wind speed. An increase in rainfall, wind speed, and humidity contributes to a lower prevalence of EKC cases during the year.