The surge of acute angle-closure glaucoma during the outbreak of Omicron in a tertiary hospital in Shanghai.

BACKGROUND: Since December 2022, China has eliminated the compulsory nucleic acid screening, which led to a new pandemic of Omicron. We observed a surge of primary angle-closure glaucoma (PACG) at a largest tertiary hospital in Shanghai. We evaluated the potential relationship between the infection of Omicron and the occurrence of PACG. METHODS: In this retrospective cross-sectional study, we identified 41 patients diagnosed with PACG from 523 individuals registered in ophthalmic emergency from December 2022 to January 2023. We compared the proportion of PACG patients in all the patients registered at the ophthalmic emergency department in the corresponding period (December and January) from 2018 to 2023. RESULTS: The proportion of PACG patients rose to 6.74% and 9.13%, nearly a five-fold increase compared to the previous 1.90%. The proportion of PACG patients throughout 2022 also increased in the recent 2 months. All PACG patients in our center from Dec. 21st 2022 to Jan. 27th 2023 had positive nucleic acid tests at their initial visits. The peak of glaucoma came around Dec. 27th 2022, while the peak of the internal medicine emergency came around Jan. 5th 2023. CONCLUSIONS: The behavior pattern of the infected people and anxiety mood would induce the PACG attack. Some ophthalmic advice should be added to the Chinese treatment guidelines for COVID-19. Also, a shallow anterior chamber and narrow angle need to be ruled out when necessary. Further studies on larger populations are needed to explore the relationship between PACG and Covid.

Bilateral anterior ischemic optic neuropathy and choroidal ischemia in a patient with COVID-19 infection.

A 57-year-old male known case of diabetes mellitus presented with gradually bilateral decreased vision accompanied by ocular pain two weeks after diagnosis of SARS-CoV-2 infection. The results of examination and imaging were indicative of bilateral anterior ischemic optic neuropathy (AION) and massive choroidal ischemia, which may be associated with SARS-CoV-2-induced damages, including endothelial damage, hypercoagulable state, and hypoxia.

Acute angle-closure glaucoma concurrent with COVID 19 infection; case report.

INTRODUCTION: To report three cases that developed acute angle-closure glaucoma on the background of hyponatremia due to COVID 19 infection. METHODS: Data of patients with positive PCR result for COVID 19 infection and concurrent findings of acute angle-closure glaucoma were analysed retrospectively. RESULTS: The common characteristic of all cases was positive PCR test for COVID 19 infection taken from the nasopharyngeal swab 4 or 5 days ago. Their serum sodium levels were lower than 135 mmol / L. At the initial ophthalmic examination, all cases had diffuse corneal edema with shallow anterior chambers and mid-dilated non-reacting pupils.The choroid was evaluated as normal by ocular ultrasonography. Intraocular pressures (IOP) of the first, second, and third cases were 35 mmHg, 44 mmHg, and 40 mm Hg, respectively. 5-10 cc/kg mannitol was given to all patients intravenously within 30 min. Simultaneously, they began to use oral acetazolamide, topical pilocarpine, beta-blocker, and prednisolone acetate drops.After stabilization of IOP, Neodymium-doped yttrium aluminum garnet;(ND: YAG) Laser iridotomy was performed on all patients. No additional fluid therapy was given to the patients other than mannitol, and it was determined that the blood sodium level remained at normal levels after diuresis. DISCUSSION: Hyponatremia is the most common electrolyte disorder in COVID 19 infection. Hyponatremia may cause an angle-closure attack in patients with shallow anterior chamber angles.Therefore, one should be aware of the possibility of angle-closure glaucoma in patients who develop hyponatremia due to COVID 19 disease. Suspected patients should be referred to the ophthalmology department.

Vision-Threatening Ocular Adverse Events after Vaccination against Coronavirus Disease 2019.

A single-center retrospective observational case series was conducted. This case series enrolled patients who showed ophthalmic manifestations within one week after COVID-19 vaccination at Korea University Guro Hospital in Seoul, Korea, from May 2021 to January 2022. The medical records of patients who complained of ocular symptoms and showed ophthalmic adverse events within one week after COVID-19 vaccination were reviewed. Seventeen eyes from 16 patients with a mean age of 63.8 (range 33-83) years were included in the case series, and all symptoms developed within 1-7 days following inoculation. Retinal vein occlusion in nine eyes (52.9%), retinal artery occlusion in one eye (5.9%), newly developed anterior uveitis in one eye (5.9%), exacerbation of previously diagnosed panuveitis in two eyes (11.8%), and angle-closure attack with high intraocular pressure in four eyes (23.5%) were included. Twelve patients (75%) had been vaccinated with the AstraZeneca (AZD1222) and four (25%) with the Pfizer (BNT162b2) vaccines. Of these, 10 patients (62.5%) experienced ocular disease exacerbation after the first dose, 4 (25%) after the second dose, and 2 (12.5%) after the third dose (booster shot). Eleven patients (64.7%) underwent tests for hematological abnormalities, and three of them tested positive for anti-PF4 antibodies, but no abnormal findings were noted. A causal relationship between vaccination and the ocular manifestations could not be determined, which is a limitation of this study. However, clinicians should consider the effect of COVID-19 vaccination on ophthalmic disease. Further studies are required to elucidate the possible effects of COVID-19 vaccination on the eye.

Spontaneous suprachoroidal haemorrhage in haemophilia coincident with ChAdOx1 nCoV-19 vaccine.

PURPOSE: To report a case of spontaneous suprachoroidal haemorrhage in a haemophilia patient immediately following ChAdOx1 nCoV-19 vaccination. CASE PRESENTATION: A 60-year-old man with haemophilia developed painful vision loss in his left eye a day following the ChAdOx1 nCoV-19 vaccination due to acute angle-closure glaucoma from a massive suprachoroidal haemorrhage. He had an extremely deranged coagulation profile; activated partial thromboplastin time (APTT): 89 s, normal range 29-35 s After factor VIII transfusion, ocular hypotensive therapy and systemic/topical steroids, the suprachoroidal haemorrhage and glaucoma resolved, but the vision remained poor. CONCLUSION: Spontaneous suprachoroidal haemorrhage may be seen in haemophiliacs with deranged coagulation profiles. In our case, it followed ChAdOx1 nCoV-19 vaccination, and we recommend caution and checking the coagulation profile in such patients apriori.

Challenges in managing glaucoma-related morbidity due to lockdown in a developing country.

Objective: The aim of this study was to assess the ocular morbidity due to delayed presentation in glaucoma patients because of COVID lockdown. Methodology: This was a retrospective study of 15 cases presented to us between October 2020 and February 2021. Cause of glaucoma in our study group was either primary angle closure, pseudoexfoliation, lens-induced glaucoma, or neovascular glaucoma. The cause of delayed presentation was identified and patients were treated with antiglaucoma medications, Nd-Yag laser, and surgery as per the standard treatment protocol. Results: With both medical and surgical intervention, some useful vision was restored in five cases while in rest it was not salvageable. The vision in the affected eye ranged from 6/60 in Snellen's chart to perception of light and projection of rays positive. Better results were achieved in angle, closure, and lens-induced glaucoma cases as compared to neovascular glaucoma cases. Conclusion: The time of presentation in such cases is as important as the etiopathogenesis. We are left with limited treatment options if the presentation is late. The lockdown ended but it unraveled quite a few instances of disease presentation which were totally preventable under normal circumstances. Introspection on finding out newer and proactive methods to reach people suffering from such irreversible but preventable diseases is the need of the day especially when preventable but irreversible diseases like glaucoma are considered.