Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.

BACKGROUND: To evaluate the association between COVID-19 vaccination and retinal vein occlusion (RVO). METHODS: This multicentre self-controlled case series included patients with RVO seen in five tertiary referral centres in Italy. All adults who received at least one dose of the BNT162b2, ChAdOx1 nCoV-19, mRNA-1273 or Ad26.COV2.S vaccine and had a first diagnosis of RVO between January 01, 2021, and December 31, 2021 were included. Incidence rate ratios (IRRs) of RVO were estimated using Poisson regression, comparing rates of events in a 28-day period following each dose of vaccination and in the unexposed control periods. RESULTS: 210 patients were included in the study. No increased risk of RVO was observed after the first dose (1-14 days IRR: 0.87, 95% CI: 0.41-1.85; 15-28 days IRR: 1.01, 95% CI: 0.50-2.04; 1-28 days IRR: 0.94, 95% CI: 0.55-1.58) and second dose of vaccination (1-14 days IRR: 1.21, 95% CI: 0.62-2.37; 15-28 days IRR: 1.08, 95% CI: 0.53-2.20; 1-28 days IRR: 1.16, 95% CI: 0.70-1.90). No association between RVO and vaccination was found in subgroup analyses by type of vaccine, gender and age. CONCLUSIONS: This self-controlled case series found no evidence of an association between RVO and COVID-19 vaccination.

A lack of an association between COVID-19 vaccination and corneal graft rejection: results of a large multi-country population based study.

PURPOSE: The aim of the study was to present the rates of corneal transplant rejection from 2018 to 2022 at both Moorfields Eye Hospital UK, and Ospedali Privati Forli (OPF) "Villa Igea", Italy and evaluate the purported association between COVID-19 vaccination and rejection. METHODS: We performed a retrospective review of rejection cases presenting to the two units. Monthly rates were correlated against regional vaccination programme rates. At OPF, conditional Poisson regression model was employed to estimate the incidence risk ratio (IRR) of graft rejection following COVID-19 vaccination risk period compared with the control period. RESULTS: Between January 2018 and March 2022, there were 471 (Moorfields), 95 (OPF) episodes of rejection. From the start of vaccination programme in the UK in late January 2021, the median number of graft rejections per month at Moorfields was 6 (range: 5-9), which was not significantly different to post-lockdown, pre-vaccination programme (March 2020-January 2021), p = 0.367. At OPF, the median rates of rejection before and after initiation of the vaccination programme were not significantly different (p = 0.124). No significant increase in incidence rate of rejection in the risk period following COVID-19 vaccination was found (IRR = 0.53, p = 0.71). CONCLUSION: No notable increase in rates of transplant rejection was noted in year 2021 when COVID-19 vaccination was broadly implemented. The apparent temporal relationship between COVID-19 vaccination and corneal graft rejection highlighted in several case reports may not represent a causative association.

Outcomes of cataract surgery with toric intraocular lens implantation after keratoplasty.

PURPOSE: To evaluate the efficacy and predictability of cataract extraction with toric intraocular lens (IOL) implantation after deep anterior lamellar keratoplasty (DALK) or mushroom penetrating keratoplasty (PK). SETTING: Villa Igea Hospital, Forlì, Italy. DESIGN: Prospective case series. METHODS: Toric IOL implantation was offered to patients with cataract, corneal astigmatism >1.5 diopters (D) and regular central corneal topography after complete suture removal. Phacoemulsification was performed through a 2.4 mm scleral tunnel and an enVista monofocal toric MX60T or Eyecryl monofocal toric IOL was inserted in the capsular bag. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, total prediction error, and IOL misalignment. RESULTS: 37 consecutive patients who had previously undergone either DALK (n = 27, 73%) or 2-piece mushroom PK (n = 10, 27%) were included. All patients completed the 6-month follow-up. The mean toric IOL power was 5.3 ± 1.1 D. Both UDVA and CDVA significantly improved (from 1.02 ± 0.27 to 0.46 ± 0.31 logMAR and from 0.65 ± 0.27 to 0.11 ± 0.12 logMAR, respectively; P < .001). 20 eyes (54%) reached UDVA ≥20/40, whereas 35 eyes (95%) reached a CDVA ≥20/40. Final refractive astigmatism was 0.93 ± 0.87 D, with 35 eyes (95%) within 2 D. Prediction error was ≤1 D in 18 eyes (49%). Absolute IOL misalignment was 3.3 ± 3.5 degrees. CONCLUSIONS: Toric IOL implantation in postkeratoplasty eyes allowed reduction of refractive astigmatism to predictably low levels with concomitant improved visual outcomes.

COVID-19 Vaccination May Not Increase Rates of Corneal Graft Rejection.

PURPOSE: The aim of the study was to present the rates of rejection from 2018 to 2021 and evaluate the purported association between COVID-19 vaccination and corneal graft rejection. METHODS: Cases of corneal graft rejection diagnosed between January 2018 and December 2021 were reviewed. The conditional Poisson regression model of the self-controlled case series method was used to estimate the incidence risk ratio of graft rejection after COVID-19 vaccination risk period compared with the control period. Based on outcomes of eyes that underwent keratoplasty from January 2018 to December 2020, Cox proportional hazard models were fitted with previous COVID-19 vaccination as a time-varying covariate. RESULTS: Over the past 4 years, the annual tally of diagnosed cases of graft rejection (19 cases in year 2018, 19 cases in year 2019, 21 cases in year 2020, and 18 cases in year 2021) has remained relatively stable. Using the conditional Poisson regression analysis, no significant increase in the incidence rate of rejection in the risk period after COVID-19 vaccination was found (incidence risk ratio = 0.56, 95% confidence interval [CI] = 0.13-2.28, P = 0.70). Fitted as a time-varying covariate, previous COVID-19 vaccination was not associated with graft rejection in both unadjusted (hazard ratio =0.77, 95% CI = 0.29-5.46, P = 0.77) and adjusted Cox models (hazard ratio = 0.75, 95% CI = 0.10-5.52, P = 0.78). CONCLUSIONS: No notable increase in rates of corneal graft rejection was noted in year 2021 when COVID-19 vaccination was broadly implemented. The apparent temporal relationship between COVID vaccination and corneal graft rejection may not represent a causative association.

Diurnal changes of noninvasive parameters of ocular surface in healthy subjects before and after continuous face mask wearing during the COVID-19 pandemic.

To investigate whether diurnal changes in noninvasive ocular surface parameters and subjective symptoms occur in healthy subjects wearing face mask who were analyzed before and after 8 h of continuous use. In this prospective cross-sectional study, healthy volunteers attending the same workplace environment underwent a noninvasive ocular surface workup by means of Keratograph 5 M (Oculus, Wetzlar, Germany) in the same day at 2 different time points: (i) in the early morning before wearing face mask (T0); (ii) after 8 h of continuous face mask use (T1). Noninvasive break-up time (NIBUT), tear meniscus height (TMH), ocular redness and meibomian gland dropout were measured. All subjects were asked to complete the Ocular Surface Disease Index (OSDI) questionnaire before and after 8 h of face mask wearing. Data from 20 healthy subjects (10 males and 10 females, mean age 25.1 ± 3.9 years) were included. Mean value of TMH decreased significantly from 0.29 ± 0.07 at T0 to 0.23 ± 0.07 mm at T1 (P < 0.001); conversely, mean values of NIBUT, redness score and meibomian gland dropout did not change significantly after continuous face mask wearing (always P > 0.532). Concerning ocular discomfort symptoms, mean value of OSDI score worsened significantly at T1 compared to T0 (from 12.9 ± 12.6 to 19.4 ± 12.0; P = 0.017). Continuous face mask wearing for 8 h led to decreased TMH associated with the onset of ocular discomfort symptoms in young healthy subjects.

Experimental testing of air filter efficiency against the SARS-CoV-2 virus: The role of droplet and airborne transmission.

Verifying the capacity of different types of air filters to stop the propagation of the SARS-CoV-2 virus has become a strategic element to contain viral spreading in enclosed spaces. This paper shows the results of experimental tests about the capacity of different commercial filter grades to stop SARS-CoV-2 propagation using inactivated virions. In the first test, the obtained results showed that the F8 filter blocks SARS-CoV-2 propagation if it encounters a flow devoid of liquid phase, i.e., a biphasic flow that can wet the filtering material. On the contrary, as shown in the second test, the SARS-CoV-2 virus propagates through the F8 filter if the droplet content in the air flow is enough to wet it. In these operational conditions, i.e., when the filter is wet by a flow with a high droplet content, the absolute H14 filter was also shown to fail to stop the transmission of the SARS-CoV-2 virus. Lastly, in the third test, the viral load was shown to be stopped when the pathway of the infected droplet is blocked.

Drug repositioning by merging active subnetworks validated in cancer and COVID-19.

Computational drug repositioning aims at ranking and selecting existing drugs for novel diseases or novel use in old diseases. In silico drug screening has the potential for speeding up considerably the shortlisting of promising candidates in response to outbreaks of diseases such as COVID-19 for which no satisfactory cure has yet been found. We describe DrugMerge as a methodology for preclinical computational drug repositioning based on merging multiple drug rankings obtained with an ensemble of disease active subnetworks. DrugMerge uses differential transcriptomic data on drugs and diseases in the context of a large gene co-expression network. Experiments with four benchmark diseases demonstrate that our method detects in first position drugs in clinical use for the specified disease, in all four cases. Application of DrugMerge to COVID-19 found rankings with many drugs currently in clinical trials for COVID-19 in top positions, thus showing that DrugMerge can mimic human expert judgment.

Emerging application of Google Trends searches on "conjunctivitis" for tracing the course of COVID-19 pandemic.

PURPOSE: The aim of the present study was to use Google Trends for evaluating the association between the internet searches of the term "conjunctivitis" and the daily new cases of COVID-19. METHODS: The relative search volume (RSV) of conjunctivitis from January 1 to April 16, 2019 (control group), January 1 to April 16, 2020 (first wave), and October 1 to December 31, 2020 (second wave) was obtained using Google Trends in Italy, France, United Kingdom, and United States. The number of COVID-19 daily new cases in the same countries were retrieved from Worldometer. Lag time correlation analyses were performed to evaluate the relationship between RSV and daily new cases (Pearson's correlation coefficient). RESULTS: During the first wave, the lagged RSV of conjunctivitis was significantly correlated with the number of COVID-19 daily new cases in all investigated countries. The highest correlation coefficients were obtained with a lag of 16 days in Italy (R = 0.868), 18 days in France (R = 0.491), 15 days in United Kingdom (R = 0.883), and 14 days in United States (R = 0.484) (all p < 0.001). Conversely, no significant correlations were found in the second wave and in the control group. CONCLUSION: Google Trends searches on conjunctivitis were significantly correlated with COVID-19 daily new cases during the first wave in Italy, France, United Kingdom, and United States, with a lag of 14-18 days. Repeating the analysis for the second wave, however, no significant correlations were found in any of the investigated countries.

Learning from organisational changes in the management of breast cancer patients during the COVID-19 pandemic: Preparing for a second wave at a breast unit in northern Italy.

Italy was the first western country to be hit by the initial wave of severe adult respiratory syndrome coronavirus 2 pandemic, which has been more widespread in the country's northern regions. Early reports showing that cancer patients are more susceptible to the infection posed a particular challenge that has guided our Breast Unit at Hub Hospital in Trento to making a number of stepwise operational changes. New internal guidelines and treatment selection criteria were drawn up by a virtual multidisciplinary tumour board that took into account the risks and benefits of treatment, and distinguished the patients requiring immediate treatment from those whose treatment could be delayed. A second wave of the pandemic is expected in the autumn as gatherings in closed places increase. We will take advantage of the gained experience and organisational changes implemented during the first wave in order to improve further, and continue to offer breast cancer management and treatment to our vulnerable patient population.

Finding disease modules for cancer and COVID-19 in gene co-expression networks with the Core&Peel method.

Genes are organized in functional modules (or pathways), thus their action and their dysregulation in diseases may be better understood by the identification of the modules most affected by the disease (aka disease modules, or active subnetworks). We describe how an algorithm based on the Core&Peel method is used to detect disease modules in co-expression networks of genes. We first validate Core&Peel for the general task of functional module detection by comparison with 42 methods participating in the Disease Module Identification DREAM challenge. Next, we use four specific disease test cases (colorectal cancer, prostate cancer, asthma, and rheumatoid arthritis), four state-of-the-art algorithms (ModuleDiscoverer, Degas, KeyPathwayMiner, and ClustEx), and several pathway databases to validate the proposed algorithm. Core&Peel is the only method able to find significant associations of the predicted disease module with known validated relevant pathways for all four diseases. Moreover, for the two cancer datasets, Core&Peel detects further eight relevant pathways not discovered by the other methods used in the comparative analysis. Finally, we apply Core&Peel and other methods to explore the transcriptional response of human cells to SARS-CoV-2 infection, finding supporting evidence for drug repositioning efforts at a pre-clinical level.

Acute Acquired Concomitant Esotropia From Excessive Application of Near Vision During the COVID-19 Lockdown.

The public health measures imposed in many countries to slow the spread of the novel coronavirus (COVID-19) outbreak could have negative effects on children's physical and mental health. The authors describe four cases of acquired concomitant acute esotropia likely caused from excessive application of near vision during the COVID-19 lockdown. [J Pediatr Ophthalmol Strabismus. 2020;57:e88-e91.].

Impending Central Retinal Vein Occlusion in a Patient with Coronavirus Disease 2019 (COVID-19).

PURPOSE: To report a case of impending central retinal vein occlusion (iCRVO) in a COVID-19 patient. CASE REPORT: A 54 years old woman with COVID-19 related pneumonia presented to our emergency department complaining of scotomas and decreased vision in her right eye. Funduscopic examination and multimodal imaging revealed rare retinal hemorrhages, retinal whitening, and fern-like hypo-autofluorescent appearance typical of iCRVO. She had no risk factors other than a transient hyper-coagulability status likely related to the ongoing infection. Systemic treatment with steroids normalized her inflammatory and coagulation status and the occlusion completely resolved. CONCLUSIONS: Retinal circulation should be considered as a potential site for thromboembolic complications from COVID-19.

Therapeutic Effects of Lactoferrin in Ocular Diseases: From Dry Eye Disease to Infections

Lactoferrin is a naturally occurring iron-binding glycoprotein, produced and secreted by mucosal epithelial cells and neutrophils in various mammalian species, including humans. It is typically found in fluids like saliva, milk and tears, where it reaches the maximum concentration. Thanks to its unique anti-inflammatory, antioxidant and antimicrobial activities, topical application of lactoferrin plays a crucial role in the maintenance of a healthy ocular surface system. The present review aims to provide a comprehensive evaluation of the clinical applications of lactoferrin in ocular diseases. Besides the well-known antibacterial effect, novel interest has been rising towards its potential application in the field of dry eye and viral infections. A growing body of evidence supports the antimicrobial efficacy of lactoferrin, which is not limited to its iron-chelating properties but also depends on its capability to directly interact with pathogen particles while playing immunomodulatory effects. Nowadays, lactoferrin antiviral activity is of special interest, since lactoferrin-based eye drops could be adopted to treat/prevent the new severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, which has conjunctivitis among its possible clinical manifestations. In the future, further data from randomized controlled studies are desirable to confirm the efficacy of lactoferrin in the wide range of ocular conditions where it can be used.