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1.
Eur J Ophthalmol ; : 11206721221090697, 2022 Mar 31.
Article in English | MEDLINE | ID: covidwho-1775239

ABSTRACT

INTRODUCTION: To report two cases of Acute Macular Neuroretinopathy (AMN) presented as the first stage of SARS-CoV-2 infection in two European countries during the third wave of pandemic viral infection in the early months of 2021. OBSERVATIONS: A unilateral case of type 1 AMN in a man and a bilateral case of type 2 AMN in an otherwise heathy patients were reported. Sudden onset of paracentral scotoma characterized the cases with no systemic symptoms. Structural optical coherence tomography (OCT) shows multifocal middle and inner retinal hyperreflective infarctions. OCT-Angiography showed the presence of hypoperfusion of the deep capillary plexus (DCP) corresponding to the hyperreflective lesions visible on structural OCT, confirming the diagnosis. CONCLUSIONS AND IMPORTANCE: Type 1 and type 2 AMN may be the first stage of SARS-CoV-2 infection. We suggest testing all patients with AMN for SARS-CoV-2. In our cases, the natural history of AMN associated with SARS-CoV-2 infection was similar to already described cases of AMN.

2.
Am J Ophthalmol Case Rep ; 26: 101505, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1757063

ABSTRACT

Purpose: To report a case of a 7-year-old male patient with bilateral choroidal caverns (CC) and pachychoroid. Observations: During the Italian COVID-19 lockdown, a 7-year old boy presented with bilateral vision decline that had started two weeks before. Structural optical coherence tomography revealed pachychoroid and CC bilaterally. Other ocular examinations were negative. The patient had an apprehensive personality and symptoms quickly resolved when he was provided with non-prescription glasses; his visual disturbances were thus considered to be functional and factitious. Conclusions and Importance: Our patient's symptoms remind us that the distress imposed upon psychologically frail subjects by the COVID-19 pandemic may have multifaceted manifestations. The discovery of CC in a pediatric patient with healthy eyes presents us with new questions about the processes of degeneration thought to be the cause for CC. Further studies are needed to estimate the prevalence of CC in the general adult and pediatric populations, as well as in patients with chorioretinal diseases.

7.
J Med Internet Res ; 23(8): e28876, 2021 08 11.
Article in English | MEDLINE | ID: covidwho-1357482

ABSTRACT

BACKGROUND: Previous studies have suggested associations between trends of web searches and COVID-19 traditional metrics. It remains unclear whether models incorporating trends of digital searches lead to better predictions. OBJECTIVE: The aim of this study is to investigate the relationship between Google Trends searches of symptoms associated with COVID-19 and confirmed COVID-19 cases and deaths. We aim to develop predictive models to forecast the COVID-19 epidemic based on a combination of Google Trends searches of symptoms and conventional COVID-19 metrics. METHODS: An open-access web application was developed to evaluate Google Trends and traditional COVID-19 metrics via an interactive framework based on principal component analysis (PCA) and time series modeling. The application facilitates the analysis of symptom search behavior associated with COVID-19 disease in 188 countries. In this study, we selected the data of nine countries as case studies to represent all continents. PCA was used to perform data dimensionality reduction, and three different time series models (error, trend, seasonality; autoregressive integrated moving average; and feed-forward neural network autoregression) were used to predict COVID-19 metrics in the upcoming 14 days. The models were compared in terms of prediction ability using the root mean square error (RMSE) of the first principal component (PC1). The predictive abilities of models generated with both Google Trends data and conventional COVID-19 metrics were compared with those fitted with conventional COVID-19 metrics only. RESULTS: The degree of correlation and the best time lag varied as a function of the selected country and topic searched; in general, the optimal time lag was within 15 days. Overall, predictions of PC1 based on both search terms and COVID-19 traditional metrics performed better than those not including Google searches (median 1.56, IQR 0.90-2.49 versus median 1.87, IQR 1.09-2.95, respectively), but the improvement in prediction varied as a function of the selected country and time frame. The best model varied as a function of country, time range, and period of time selected. Models based on a 7-day moving average led to considerably smaller RMSE values as opposed to those calculated with raw data (median 0.90, IQR 0.50-1.53 versus median 2.27, IQR 1.62-3.74, respectively). CONCLUSIONS: The inclusion of digital online searches in statistical models may improve the nowcasting and forecasting of the COVID-19 epidemic and could be used as one of the surveillance systems of COVID-19 disease. We provide a free web application operating with nearly real-time data that anyone can use to make predictions of outbreaks, improve estimates of the dynamics of ongoing epidemics, and predict future or rebound waves.


Subject(s)
COVID-19 , Epidemics , Forecasting , Humans , SARS-CoV-2 , Search Engine
9.
J Clin Med ; 10(6)2021 Mar 18.
Article in English | MEDLINE | ID: covidwho-1241269

ABSTRACT

PURPOSE: To investigate whether the coronavirus disease 2019 (COVID-19) pandemic-associated postponement in care had effects on the baseline clinical presentation of patients with newly diagnosed treatment-naïve exudative neovascular age-related macular degeneration (AMD). METHODS: We included the first 50 consecutive patients referred within the COVID-19 pandemic with a diagnosis of treatment-naïve exudative neovascular AMD. Two groups of fifty consecutive patients with newly diagnosed neovascular exudative AMD presenting in 2018 and 2019 (control periods) were also included for comparisons. RESULTS: Baseline visual acuity was statistically worse in patients referred during the COVID-19 pandemic period (0.87 ± 0.51 logarithm of the minimum angle of resolution (LogMAR)) as compared with both the "2019" (0.67 ± 0.48 LogMAR, p = 0.001) and "2018" (0.69 ± 0.54 LogMAR, p = 0.012) control periods. Data on the visual function after a loading dose of anti-vascular endothelial growth factor (VEGF) was available in a subset of patients (43 subjects in 2020, 45 in 2019 and 46 in 2018, respectively). Mean ± SD best corrected visual acuity (BCVA) at the 1-month follow-up visit after the third anti-VEGF injection was still worse in patients referred during the COVID-19 pandemic (0.82 ± 0.66 LogMAR) as compared with both the "2019" (0.60 ± 0.45 LogMAR, p = 0.021) and "2018" (0.55 ± 0.53 LogMAR, p = 0.001) control periods. On structural optical coherence tomography (OCT), the maximum subretinal hyperreflective material (SHRM) height and width were significantly greater in the COVID-19 pandemic patients. CONCLUSIONS: We demonstrated that patients with newly diagnosed treatment-naïve exudative neovascular AMD referred during the COVID-19 pandemic had worse clinical characteristics at presentation and short-term visual outcomes.

10.
J Clin Med ; 10(6)2021 Mar 18.
Article in English | MEDLINE | ID: covidwho-1158382

ABSTRACT

PURPOSE: To investigate whether the coronavirus disease 2019 (COVID-19) pandemic-associated postponement in care had effects on the baseline clinical presentation of patients with newly diagnosed treatment-naïve exudative neovascular age-related macular degeneration (AMD). METHODS: We included the first 50 consecutive patients referred within the COVID-19 pandemic with a diagnosis of treatment-naïve exudative neovascular AMD. Two groups of fifty consecutive patients with newly diagnosed neovascular exudative AMD presenting in 2018 and 2019 (control periods) were also included for comparisons. RESULTS: Baseline visual acuity was statistically worse in patients referred during the COVID-19 pandemic period (0.87 ± 0.51 logarithm of the minimum angle of resolution (LogMAR)) as compared with both the "2019" (0.67 ± 0.48 LogMAR, p = 0.001) and "2018" (0.69 ± 0.54 LogMAR, p = 0.012) control periods. Data on the visual function after a loading dose of anti-vascular endothelial growth factor (VEGF) was available in a subset of patients (43 subjects in 2020, 45 in 2019 and 46 in 2018, respectively). Mean ± SD best corrected visual acuity (BCVA) at the 1-month follow-up visit after the third anti-VEGF injection was still worse in patients referred during the COVID-19 pandemic (0.82 ± 0.66 LogMAR) as compared with both the "2019" (0.60 ± 0.45 LogMAR, p = 0.021) and "2018" (0.55 ± 0.53 LogMAR, p = 0.001) control periods. On structural optical coherence tomography (OCT), the maximum subretinal hyperreflective material (SHRM) height and width were significantly greater in the COVID-19 pandemic patients. CONCLUSIONS: We demonstrated that patients with newly diagnosed treatment-naïve exudative neovascular AMD referred during the COVID-19 pandemic had worse clinical characteristics at presentation and short-term visual outcomes.

11.
Eur J Ophthalmol ; 32(1): 695-703, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1136200

ABSTRACT

BACKGROUND/OBJECTIVES: To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control). METHODS: Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value <0.05 was considered significant. RESULTS: A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65-0.80 and 0.61-0.75, respectively, p < 0.001 for both). CONCLUSION: This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.


Subject(s)
COVID-19 , Retinal Detachment , Communicable Disease Control , Humans , Retrospective Studies , SARS-CoV-2
12.
Eur J Ophthalmol ; 31(3): 849-852, 2021 May.
Article in English | MEDLINE | ID: covidwho-835729

ABSTRACT

In the last months, a rapidly increasing number of people have been infected with severe acute respiratory syndrome coronavirus 2, the virus causing coronavirus disease 2019 (COVID-19). Due to the risk of cross-infections, the number of visits and injections was dramatically reduced in the last months, and the time between visits has been rescheduled from every 15 to 45 min, significantly impairing the total number of available visits. Although continuity of care has been allowed, a series of measures to diminish the risk of contamination need to be adopted until the end of this pandemic outbreak, which may persist until the development of an effective vaccine. For these reasons, we have introduced a new treatment regimen that is aimed at reducing the number of in-person visits and achieving continuity of treatment. This regimen is named "Triple and Plan" (TriPla). The main advantage of the TriPla regimen is to reduce the number of visits of patients in comparison to the pro re nata and treat and extend regimen. Using the TriPla regimen, the risk of contamination would be reduced. Furthermore, by reducing the number of scheduled visits, physicians could guarantee an adequate number of examinations for each patient, lengthening the interval between visits, and reducing the risk of cross-infections.


Subject(s)
COVID-19 , Macular Degeneration , Wet Macular Degeneration , Angiogenesis Inhibitors/therapeutic use , Follow-Up Studies , Humans , Intravitreal Injections , Macular Degeneration/drug therapy , Ranibizumab/therapeutic use , SARS-CoV-2 , Tomography, Optical Coherence , Treatment Outcome , Visual Acuity
14.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2621-2628, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-812593

ABSTRACT

PURPOSE: To estimate the impact of delayed care during the coronavirus disease 2019 (COVID-19) pandemic on the outcomes of patients with neovascular age-related macular degeneration (AMD). METHODS: Consecutive patients with diagnosis of neovascular AMD were consecutively enrolled between March 9, 2020, and June 12, 2020, (during and immediately after the Italian COVID-19 quarantine). During the inclusion (or pandemic) visit (V0), patients received a complete ophthalmologic evaluation, including optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and OCT findings from the two preceding visits (V-1 and V-2) were compared with data at V0. RESULTS: One-hundred patients (112 eyes) were enrolled in this study. The time interval between following visits was 110.7 ± 37.5 days within V0 and V-1 and 80.8 ± 39.7 days within V-1 and V-2, respectively (P < 0.0001). BCVA was statistically worse at the V0 visit as compared with the immediately preceding (V-1) visit (0.50 ± 0.43 LogMAR and 0.45 ± 0.38 LogMAR at the V0 and V-1 visits, respectively; P = 0.046). On structural OCT, 91 out of 112 (81.2%) neovascular AMD eyes displayed the evidence of exudative disease activity at the V0 visit, while 77 (68.7%) eyes exhibited signs of exudation at the V-1 visit (P = 0.022). No differences in terms of BCVA and OCT findings were detected between the V-1 and V-2 visits. In multiple regression analysis, the difference in BCVA between V0 and V-1 visits was significantly associated with the interval time within these two visits (P = 0.026). CONCLUSION: The COVID-19 pandemic-related postponement in patient care proved to be significantly associated with worse short-term outcomes in these patients.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Betacoronavirus , Choroidal Neovascularization/drug therapy , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Retinal Neovascularization/drug therapy , Time-to-Treatment , Wet Macular Degeneration/drug therapy , Aged , Aged, 80 and over , Bevacizumab/therapeutic use , COVID-19 , Choroidal Neovascularization/diagnostic imaging , Choroidal Neovascularization/physiopathology , Female , Humans , Intravitreal Injections , Male , Middle Aged , Pandemics , Quarantine , Ranibizumab/therapeutic use , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Retinal Neovascularization/diagnostic imaging , Retinal Neovascularization/physiopathology , SARS-CoV-2 , Subretinal Fluid , Tomography, Optical Coherence , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Wet Macular Degeneration/diagnostic imaging , Wet Macular Degeneration/physiopathology
15.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2655-2660, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-777820

ABSTRACT

PURPOSE: To quantify the shrinking in outpatient and intravitreal injections' volumes in a tertiary referral retina unit secondary to virus causing coronavirus disease 2019 (COVID-19). METHODS: In this retrospective cross-sectional study, we reviewed the charts of all patients who had a visit at a medical retina referral center during the Italian quarantine (from 9th of March 2020 to 3rd of May 2020). Number and characteristics of these data were compared with data from the same period in 2019 (from 9th of March 2019 to 3rd of May 2019). RESULTS: In the 2019 study period, there were 303 patients attending clinic (150 males, 153 females). In the 2020 study period, patients decreased to 75 (48 males, 27 females; P = 0.022 comparing gender prevalence between the two periods) with an overall reduction of 75.2%. Mean ± SD age was 71.4 ± 14.3 years (range 25-93 years) in the 2019 study period and 66.7 ± 13.1 years (range 32-91 years) in the 2020 study period (P = 0.005). The largest drop in outpatient volume was recorded in AMD patients (- 79.9%). Regarding the intravitreal treatments, there were 1252 injections in the 2019 period and 583 injections in the 2020 period (- 53.6% in injections). The drop in intravitreal treatments was larger in patients with posterior uveitis, retinal vein occlusion, and diabetes (- 85.7%, - 61.9%, and - 59.6%, respectively). CONCLUSION: The volume of outpatient visits and intravitreal injections declined during the COVID-19 quarantine. The short- and long-term impacts are that routine in-person visits and intravitreal injections are expected to increase after the quarantine and, even more, after the pandemic.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Betacoronavirus , Coronavirus Infections/epidemiology , Office Visits/statistics & numerical data , Outpatients/statistics & numerical data , Pneumonia, Viral/epidemiology , Retinal Diseases/drug therapy , Adult , Aged , Aged, 80 and over , COVID-19 , Cross-Sectional Studies , Female , Humans , Intravitreal Injections , Italy/epidemiology , Male , Middle Aged , Pandemics , Quarantine , Referral and Consultation/statistics & numerical data , Retinal Diseases/diagnosis , Retinal Diseases/physiopathology , Retrospective Studies , SARS-CoV-2 , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology
16.
Ocul Immunol Inflamm ; 28(6): 916-921, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-737751

ABSTRACT

PURPOSES: To describe the prevalence of ocular features among COVID-19 patients and their relationship with clinical data, inflammatory markers and respiratory support therapy (including CPAP); to investigate SARS-CoV-2 in ocular secretions of symptomatic patients. METHODS: 172 COVID-19 patients were evaluated for presence of ocular manifestations. Clinical and laboratory data were also reviewed. Conjunctival swabs were analyzed for SARS-CoV-2 by RT-PCR. RESULTS: Forty-five patients (26.2%) reported ocular manifestations. Patients treated with CPAP were more likely to have ocular abnormalities (p <.01). The presence of ocular symptoms was not associated with more significant alterations on blood tests. Conjunctival swabs from patients with suspect conjunctivitis yielded negative results for SARS-CoV-2. CONCLUSIONS: Ocular features are not infrequent in COVID-19 patients, but the presence of SARS-CoV-2 in ocular secretions is low. Ocular manifestations in hospitalized COVID-19 patients can also be a consequence of respiratory support therapy. Prevention of possible transmission through ocular secretions is still recommended.


Subject(s)
Betacoronavirus/genetics , Conjunctiva/virology , Conjunctivitis, Viral/etiology , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , RNA, Viral/analysis , COVID-19 , Conjunctivitis, Viral/diagnosis , Conjunctivitis, Viral/virology , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pneumonia, Viral/epidemiology , SARS-CoV-2
18.
Eur J Ophthalmol ; 30(5): 1185-1187, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-378194

ABSTRACT

SARS-CoV-2 infection recently reached pandemic proportions, with high risk of death for the worldwide population. In this dramatic scenario, all the resources are addressed to the intensive care units for the assessment of the emergency. However, more attention should be paid with respect to the risk of viral diffusion among asymptomatic people. Italy is the second most involved country in the world, and we needed to gain a lot of experience in a very limited time. At least 1 m of distance among people is recommended; however, some clinical practices cannot allow this distance. In this context, we believe that the careful safety assessment of clinical settings, like ophthalmologic ones, may have a remarkable impact on the fight against SARS-CoV-2 spread.


Subject(s)
Betacoronavirus , Blindness/epidemiology , Coronavirus Infections/complications , Ophthalmology , Pandemics , Pneumonia, Viral/complications , Blindness/etiology , COVID-19 , Coronavirus Infections/epidemiology , Global Health , Humans , Incidence , Pneumonia, Viral/epidemiology , SARS-CoV-2
19.
Eur J Ophthalmol ; 30(4): 621-628, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-291469

ABSTRACT

INTRODUCTION: The novel coronavirus (SARS-CoV-2) is infecting people and spreading easily from person-to-person. Cases have been detected in most countries worldwide. Italy is one of the most affected countries as of 30 March 2020. Public health response includes a rapid reorganization of the Italian National Healthcare System in order to reduce transmission of COVID-19 within hospitals and healthcare facilities, while optimizing the assistance to patients with severe COVID-19 complications. METHODS: We analysed the actions that were taken in three ophthalmology centres in northern Italy during the SARS-CoV-2 outbreak and how these measures affected patient's attendance. In addition, due to the rapidly evolving scenario, we reviewed the evidence available during the course of this pandemic. RESULTS: A full reorganization of ophthalmology services is mandatory according to current existing infection containment measures in order to continue dispensing urgent procedures without endangering the community with amplification of the diffusion chain. Ophthalmologists are considered at elevated risk of exposure when caring patients and vice versa, due to their close proximity during eye examination. High volumes of procedures typically generated by ophthalmologists with concurrent implications on the risk of infection are considered when re-assessing healthcare facilities reorganization. CONCLUSION: Containment measures in the event of pandemic due to infective agents should be well known by healthcare professionals and promptly applied in order to mitigate the risk of nosocomial transmission and outbreak.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Ophthalmology/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Cross Infection/transmission , Eye Diseases/diagnosis , Eye Diseases/therapy , Humans , Infection Control/organization & administration , Italy/epidemiology , Ophthalmology/standards , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2 , Triage/organization & administration
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