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Objectives: Globally, cataract and glaucoma are the predominant causes of blindness. Screening glaucoma in patients referred for cataract surgery is a convenient tool for detecting glaucoma cases in rural population. The COVID period has adversely affected eye care as the routine screening and follow-ups at hospital were substantially reduced owing to pandemic restrictions. We aim to study the impact of COVID on detection of glaucoma in patients with cataract. Method(s): It was a retrospective study conducted to compare the prevalence of glaucoma in rural patients presenting with cataract pre- and post-COVID. Details of 975 consecutive patients each were taken prior to March 2020 (pre-COVID) and after October 2021 (post-COVID) from hospital database and patient case files. Result(s): The prevalence of glaucoma was higher during the pre-COVID time (3.8%) as compared to pre-COVID (3.8%), but the result was not statistically significant. In both the groups, primary open-angle glaucoma was the pre-dominant form of glaucoma, with prevalence being 1.5% and 2.2% in the pre-COVID and post-COVID groups, respectively. The mean intraocular pressure and mean VCDR values were higher in the post-COVID group as compared to the pre-COVID group, and the result was statistically significant. Conclusion(s): This was the first study to compare the prevalence of glaucoma in patients with cataract in rural population in the pre-COVID and post-COVID periods. In the aftermath of the pandemic, the present study emphasizes the role of screening and follow-ups in glaucoma management to prevent irreversible loss of vision.Copyright © 2023 The Authors.
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Background: Acute zonal occult outer retinopathy (AZOOR) is a rare, recently introduced sectorial outer retinopathy commonly seen in young females. The presence of AZOOR in multiple sclerosis (MS) patients can sometimes masquerade as optic neuritis. We hereby analyze an infrequent case of such an incident, as well as the comorbidities of this particular patient and the arising differential diagnostic dilemmas. Case Presentation: A 29-year-old female MS patient on cladribine presented in the emergency department (ED) due to left eye (LE) visual disturbances which appeared after Covid-19 infection. As a result of her past medical history, the case was considered to be consistent with optic neuritis. The patient was treated with high doses of intravenous methylprednisolone, but despite the treatment symptoms persisted. Ophthalmological findings were compatible with AZOOR. Conclusion(s): AZOOR can coexist with MS. However, it is unclear whether cladribine treatment or Covid-19 infection triggered AZOOR. Given the potential for ocular adverse effects associated with cladribine use, patients should be encouraged to report visual disturbances promptly. In addition, medical professionals must be vigilant of MS patients on cladribine complaining of visual symptoms, and refer them to an ophthalmologist as soon as possible.Copyright © 2022 The Author(s)
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An old-aged woman was evaluated with branch retinal vein occlusion (BRVO) vision reduction in his left eye three weeks after the Sinopharm coronavirus disease 2019 (COVID-19) vaccination. Her best-corrected visual acuity (BCVA) was 1m counting finger in the left eye and 10/10 in the right eye. Initial retinal findings were superior retinal hemorrhage with prominent retinal vein dilation and tortuosity in the left eye. Fluorescein angiography (FA) and optical coherence tomography (OCT) confirmed a BRVO diagnosis. Blood reports showed no abnormalities. Antithrombotic treatment of 80 mg/d low-dose entrocoated ASA was administered. In addition, an intravitreal Aflibercept (Eylea) injection, monthly and ongoing, was prescripted, which led to a decrease in macular edema, retinal hemorrhage, and height of serous retinal detachment. Moreover, the BCVA improved to 2/10 after a three-week follow-up.Copyright © 2023, Journal of Kermanshah University of Medical Sciences.
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BACKGROUND: Branch retinal vein occlusion (BRVO) has an incidence of 0.5-1.2%. COVID-19 is associated with both venous and arterial thromboembolisms due to excessive inflammation, hypoxia, immobilization, and diffuse intravascular coagulation. AIM: The present study aims to describe our experience with BRVO in Egyptian COVID-19 patients. PATIENTS AND METHODS: The present retrospective study included 17 polymerase chain reaction (PCR)-proven COVID-19 patients with BRVO. Data obtained from the studied patients included detailed history taking. In addition, patients were diagnosed with BRVO based on a comprehensive ophthalmic evaluation, including logMAR Best-corrected visual acuity assessment, slit-lamp bio-microscopy, fundoscopy, fundus fluorescein angiography, and optical coherence tomography macular assessment. RESULT(S): The present study included 17 PCR-proven COVID-19 patients with BRVO. They comprised 9 males (52.9%) and 8 females (47.1%) with an age of 52.8 +/- 13.3 years. Fundus examination revealed BRVO as superior temporal in 9 patients (52.9%), inferior temporal in 5 patients (29.4%), superior nasal in 2 patients (11.8%), and inferior nasal in 1 patient (5.9%). The reported retinal thickness was 355.7 +/- 41.7 microm. In addition, fundus fluorescein angiography identified ischemic changes in 2 patients (11.8%). CONCLUSION(S): BRVO is a rare severe complication of COVID-19 infection. In patients with proven or suspected infection with a diminution of vision, there should be high suspicion of BRVO and prompt full-scale ophthalmological examination to exclude the condition. Copyright © 2022 Sanaa Ahmed Mohamed, Marwa Byomy, Eman El Sayed Mohamed El Sayed, Mostafa Osman Hussein, Marwa M. Abdulrehim, Ahmed Gomaa Elmahdy.
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*AIM: To identify the reasons for not improving visual acuity of patients with diabetic macular edema (DME) and its correlation with optical coherent tomography (OCT) imaging characteristics. They were treated with anti - vascular endothelial growth factor (VEGF) again after an interruption of treatment due to the COVID - 19 pandemic. * METHODS: Retrospective cases study. A total of 31 patients (40 eyes) with DME and treated with anti-VEGF drugs in the Department of Ophthalmology of the First Affiliated Hospital of Xi' an Jiaotong University between December 2019 and July 2020 were selected. All patients had an treatment history of interruption due to COVID-19. Based on the behavioral standard of best corrected visual acuity (BCVA) at 1mo after re - treatment, they were divided into improved visual acuity group (14 eyes) and non-improved visual acuity group (26 eyes). All patients received comprehensive ophthalmic examinations, including BCVA, intraocular pressure, OCT, fundus photography, and fundus fluorescein angiography (FFA). The central retinal thickness (CRT), hyper - reflective retinal dots (HRD), subretinal fluid (SRF), intraretinal fluid (IRF), disorganization of the inner retinal layers (DRIL) and ellipsoid zone disruption (EZD) were quantified by Image J. The correlation between BCVA and CRT, the number of HRD, the diameter of SRF and IRF, and the height of DRIL and EDZ width at 1mo after treatment were analyzed by Spearman correlation. * RESULTS: The proportion of HRD in OCT was significantly higher in the non - improved visual acuity group than that in the improved visual acuity group (chi2 = 5.43, P = 0.0072);There was a positive correlation between the difference of BCVA (LogMAR) and CRT change in DME patients after treatment (rs = 0.406, P = 0.009);There was a positive correlation between BCVA (LogMAR) and EZD width after treatment (rs = 0.358, P = 0.023). There was no correlation between BCVA (LogMAR) after treatment and the number of CRT (rs = - 0. 086, P = 0. 600) and HRD (rs = - 0. 115, P = 0. 482), the diameter and height of SRF (rs = 0.102, P = 0.530;rs = 0.100,P = 0.538) and IRF (rs = 0.134, P = 0. 410;rs = - 0. 014, P = 0. 932), and the width of DRIL (rs = 0.089, P = 0.587). * CONCLUSION(S): The probability of retinal HRD was significantly higher in patients with no visual improvement than that in patients with visual improvement after the re - treatment with anti - VEGF due to the treatment interruption during COVID- 19. EZD width was also closely correlated to the prognosis of visual acuity. As for these patients, HRD manifestations in OCT should be comprehensively considered, taking intravitreal injection of glucocorticoid as an auxiliary strategy if necessary. Copyright © 2022 International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.
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Background: Intravitreal anti-vascular endothelial growth factor therapy currently represents the treatment standard for vision-threatening macular conditions, while treatment delays cause precipitous vision loss. The COVID-19 pandemic prompted unprecedented delays for patients receiving intravitreal injections (IVI). We aim to provide real-world data on the effects of delayed IVI treatment due to COVID-19 at our center and its associated visual consequences. Method(s): In this retrospective cohort study based at a tertiary hospital in metropolitan Brisbane, medical records were reviewed for consecutive IVI patients within a 6-week interval between March-May 2020. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit. Main outcome measures included best-corrected visual acuity (BCVA), central macular thickness as well as structural findings on OCT suggestive of disease activity. Result(s): A total of 682 patients were scheduled to receive IVI-based care, with treatment delay observed in 123 patients (18.5%) for an average period of 64 days. BCVA worsened in the delayed group by an average of 0.136 letters compared to 0.008 in the control group (p = 0.02), with the most significant change seen in neovascular age-related macular degeneration patients (p = 0.001). Patients on Aflibercept and Ranibizumab were more likely to maintain vision compared to those on Bevacizumab (p = 0.02 and p = 0.07). Retinal vein occlusion patients were most likely to suffer from longterm visual consequences from delayed follow-up. In multivariate linear regression model for risk factor analysis;BCVA, distance from hospital and patient age were all correlated with treatment delays. Conclusion(s): Patients who experienced treatment delays suffered short-term visual decline. However, visual losses were not sustained in majority of patients.
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Purpose : To assess the visual impact and reasons for treatment delay during the COVID-19 pandemic lockdown in neovascular age-related macular degeneration (nAMD) patients in ongoing anti-VEGF therapy. Methods : Retrospective, national, multicentre, observational study in nAMD patients treated with anti-VEGF therapy and registered in the Fight Retinal Blindness (FRB) Spain platform prior to lockdown. Study cohort was divided in timely treated patients (TTP) and delayed treatment patients (DTP). Mean change in best corrected visual acuity (BCVA, in ETDRS letters) from the last follow-up visit (FUV) before lockdown (BLD) (baseline [BL] visit) to the first FUV after lockdown (ALD) was assessed. A specific questionnaire was distributed to the participant centers to investigate further the reasons for treatment delay in all individual cases. Results : A total of 245 eyes fulfilled the eligibility criteria, from which 39.6% were TTP (n=97) and 60.4% were DTP (n=148). TTP presented greater baseline and final BCVA compared to DTP (64.1 vs 58.7 letters, p=0.023, and 63.6 vs 57.1, p=0.004). BCVA loss was significantly greater for DTP vs TTP (-2.0 vs -0.6 letters, p=0.016). For DTP cohort, the primary reason for visit delay was patient decision (48.2%) followed by limited hospital clinic capacity (42.7%). When patients decided not to attend scheduled visits, the main reason was fear to Covid-19 infection (49.4%). Conclusions : This study provides relevant data about the impact on visual outcomes of Covid-19 pandemic lockdown on nAMD patients and specifically provides new additional information regarding the main reasons for treatment and visits delay from both patients and healthcare service delivery perspectives.
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Purpose : The COVID-19 pandemic created an unprecedented setback for diabetic retinopathy (DR) patients receiving routine anti-vascular endothelial growth factor (VEGF) injections. In this retrospective clinical study, we assessed visual and anatomical outcomes of “late follow-up” appointments cancelled or rescheduled during an 11-week quarantine period from March 15th- June 1st, 2020, due to the urgency to limit non-emergent clinical visits. This study tested the hypothesis that strict frequency of treatment is a requisite for successful therapy. Methods : To meet “late follow-up” requirements, all study patients had appointments scheduled within the quarantine period that were delayed past their previous physician recommended interval, beyond June 1st, 2020. Of the 7042 delayed patients, 5137 returned for examination. 2764 were injection patients, of which 616 were delayed beyond the quarantine period. These 616 patients were subsequently categorized by diagnosis. We then analyzed the electronic medical record (EMR) for 300 eyes with treatment-requiring diabetic retinopathy to establish baseline anatomical and visual status prior to the delayed clinical visit. The EMR of the follow-up appointment was subsequently viewed for comparison. Best-corrected visual acuity (BCVA) and retinal examination findings were recorded from both visits. All eyes received at least 1 anti-VEGF injection prior to March 15th, 2020. Results : 300 eyes were delayed beyond their previously scheduled interval an average of 14.04 weeks. Upon return, 37 eyes (12.3%) had improved BCVA, 169 (56.3%) remained stable, and 94 (31.4%) had worsened. Of the 300 eyes, there was an average of 2.2 lines lost (p=0.03). 29 delayed eyes (9.7%) returned with improved macular edema, 121 (40.3%) remained stable, and 143 (47.7%) had worsened upon examination. Due to vitreous hemorrhage, edema progression in 7 eyes (2.3%) was unknown. 290 eyes (96.7%) remained with non-proliferative DR, while 10 (3.3%) progressed to proliferative DR. 23 (7.6%) returned with new or worsened vitreous hemorrhages. No patients developed a retinal tear or detachment during this period. Conclusions : COVID-19 had a severe impact on routine clinical visits. Prolonged frequency of anti-VEGF treatment for DR is associated with increased risk for BCVA decline and negative anatomical outcomes. Effective therapy requires strict compliance with intravitreal injections and routine clinical appointments.
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Purpose : Microincision vitrectomy surgery (MIVS) studies have shown low complication rates. In the setting of the COVID-19 pandemic and rural satellite clinics, we investigated the role of telemedicine as an alternative to postoperative visit (POV) regimens after uncomplicated MIVS. Methods : This IRB approved, prospective single-site, and single-surgeon study included patients without any history of glaucoma, ocular trauma, or severe systemic or ocular disease who underwent uncomplicated MIVS for any indication between January-August 2021. Prophylactic topical pressure-lowering drops were prescribed if POV intraocular pressure (IOP) was ≥22 mmHg. POVs included the same day after surgery, week(s) 1, 2, 8, and 12. Patients were randomly assigned (1:1) into two arms: telemedicine (TM) or In-person (IP). Weeks 1 and 8 POV utilized protocol-based and questionnaire guided undilated exams performed by an ophthalmology fellow that were conducted either TM or IP, according to arm assignment. Any patients with concerning symptoms identified at these visits were scheduled for dilated exams with the surgeon. All patients underwent dilated exams performed by the surgeon on the same day after surgery, weeks 2 and 12. Primary endpoint was mean best corrected visual acuity (BCVA). Secondary endpoints included changes in intraocular pressure (IOP), retinal nerve fiber layer thickness, and number of additional visits. Statistical analysis included Mann Whitney U and chi-square tests. Results : Fifty-two eyes from 50 patients (33 female, 17 male;p-value=0.02) with mean ages of 68.4±6.8 years underwent 55 total surgeries with 25 or 27G MIVS platforms. Forty-seven patients have completed all POVs. Mean preop BCVA logMAR was 0.53±0.55 and 0.40±0.45, and at 12 weeks, they were 0.39±0.45 and 0.26±0.33 for the TM and IP groups, respectively. No significant between-group differences were found for primary or secondary outcomes. All cases of abnormal IOP resolved by the following POV with pressure lowering drops. Concerning symptoms were identified in five patients requiring additional visits, revealing two cases of worsening macular edema (1 TM and 1 IP) and one case each of cataract progression (TM), vitreous hemorrhage (IP), and macular hole recurrence (TM). No complications presented at the TM or IP visits. Conclusions : Telemedicine-assisted POV regimens may be a safe and convenient alternative for patients undergoing uncomplicated MIVS.
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Purpose : Autosomal recessive CEP290-LCA (LCA10) is a severe inherited retinal disease resulting in early vision loss and currently has no treatment. Sepofarsen is an RNA antisense oligonucleotide targeting the most common c.2991+1655A>G disease-causing variant in the CEP290 gene. Long-term safety and efficacy of sepofarsen in the first eye treated (FE) and safety and efficacy in the second eye treated (SE) in this extension trial (Insight;NCT03913130) were evaluated. Methods : Subjects who completed the Ph1b/2 sepofarsen trial could enroll in the extension trial for continued dosing in the FE and initiation in the SE with the 160/80μg loading/maintenance dose. Frequency and severity of adverse events, and change in best-corrected visual acuity (BCVA) and full-field stimulus testing (FST) threshold were assessed. Baseline was defined as the value measured within the same month of-or last measurement prior to-the first dosing for each eye. Due to covid-19, some participants have missed scheduled injections. As such data up to-or available measurement prior to-6 months after the last dosing have been included in the analysis for each eye. Results : At data cut-off in mid-October 2021, 9 subjects (of 11 from the Ph1b/2 trial) aged 15-45 years were followed up to 46 months, 5 of them received at least one intravitreal injection of sepofarsen in the SE. Three subjects developed cataracts in the FE and 2 in the SE, of which 2 recovered following cataract surgery. Time to onset since initial dose was 13 months or later. Between 35-46 months after the 1 injection, long term BCVA improvement was reported in 4/6 FE ranging from-0.20 to-0.54 logMAR and 5/5 FE improved in either blue FST, red FST or both ranging from-0.21 to-2.06 log cd/m2. The SE showed a similar trend as the FE in BCVA (3/5 SE showed a change ranging from-0.06 to-2.50 logMAR) and in blue and red FST (4/4 SE showed improvement ranging from-0.27 to-4.57 log cd/m2). st Conclusions : The longer-term sepofarsen safety profile is consistent with that observed in the Ph1b/2. Meaningful BCVA and FST improvements observed in the Ph1b/2 continued up to 46 months. The responses in the SE were similar to the responses seen in the FE in both visual acuity and retinal sensitivity improvements. A Phase 2/3 (ILLUMINATE;NCT03913143), multiple dose, double-masked, randomized, sham-controlled trial is ongoing.
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Purpose : Dry age-related macular degeneration (AMD) is a leading contributor to visual impairment across the globe. No current treatment exists to improve visual function or reduce disease progression outside of vitamin supplementation and lifestyle changes. LIGHTSITE III is evaluating multiwavelength photobiomodulation (PBM) therapy using the LumiThera Valeda® Light Delivery System in dry AMD Methods : LIGHTSITE III (NCT04065490) is a prospective, double-masked, randomized, sham-controlled, parallel group, multi-center study to assess the safety and efficacy of PBM in dry AMD. Target enrollment was approximately 96 subjects (144 eyes). Subjects are treated with six series of PBM/Sham treatments (3x per week for 3 weeks) delivered over a 24-month period with a 13-month efficacy analysis of data. PBM therapy consists of low-level light exposure to selected tissues resulting in positive effects on mitochondrial output and improvement in cellular activity. Valeda is used to deliver multiwavelength PBM treatment using 590, 660 and 850 nm of light. Subjects are assessed for clinical and safety outcomes (i.e., best-corrected visual acuity (BCVA), low- luminance BCVA, contrast sensitivity, reading speed, color vision, VFQ-25 and perimetry). Independent OCT, FAF and color fundus imaging outcomes at selected timepoints are analyzed by a masked imaging reading center Results : A total of 148 eyes from 100 subjects with dry AMD have been enrolled and randomized in a 2:1 design (PBM:Sham). The majority of subjects are female (68%) and Caucasian (99%). The average age at enrollment was 75 years and mean time since dry AMD diagnosis is 4.9 years. COVID-19 interference has been minimal and not significantly impacted subject enrollment or retention. Clinical and anatomical outcome data from the interim analysis conducted at Month 13 is presented. Results from the 21-month time point are expected at end of 2022 Conclusions : LIGHTSITE III provides the largest, randomized controlled trial evaluating the effects of PBM in dry AMD subjects. PBM therapy may offer a new treatment strategy with a unique mechanism and modality for patients with dry AMD.
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Purpose : During the emergeing COVID-19 pandemic, patient care was delayed due to clinic closures and patient hesitancy in seeking necessary care. We aimed to characterize clinical outcomes of exudative macular degeneration (AMD) patients who had delay in their care. As the uncertainly of the pandemic unfolds, this study aims to inform clinical decision making on future care delay decisions. Methods : Patients with a chart diagnosis of exudative AMD who had an appointment canceled from 3/16/20 through 5/4/20 were selected. This timeframe encompassed the official clinic closure and a time during which many patients self-delayed care. Patients with concurrent macular disease were excluded. Data from each ophthalmology encounter was collected from 3/1/2019 through 7/1/2021. A linear longitudinal multilevel model was used to model best-corrected visual acuity (BCVA) over time. Time varying covariates included injection at visit, presence of subretinal fluid, intraretinal fluid, geographic atrophy, and macular hemorrhage. Baseline covariates included age, race, sex, treatment interval, treatment vs. observation, delay interval, anti-VEGF agent, baseline subretinal fluid, intraretinal fluid, and geographic atrophy, prior PDT, and smoking status. Results : 161 eyes encompassing 2,555 ophthalmology encounters were selected. An initial model without addition of time varying or baseline predictors show a daily change in BCVA of 0.00151 logMAR (p = 0.05) over the study period. The pre-closure BCVA daily change was lower than the post-closure suggesting vision dropped at a faster rate after care delay, however this was not statistically significant (Figure 1). With time varying and baseline covariates added, intraretinal fluid status at baseline was the only statistically significant factor that predicted a larger BCVA slope (p=0.05). Conclusions : Initial data suggests that BCVA fell during the time period, but there was no significant difference between the pre-closure and post-closure data. Patients with intraretinal fluid at baseline may potentially have worse long-term visual outcomes if care is delayed. Further model refinement needs to be undertaken prior to any definite conclusions. (Figure Presented).
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Purpose : Exogenous endophthalmitis (EE) is the most serious complication of penetrating eye surgeries and open globe trauma (OGT). It is crucial to know the associated factors that will determine the final visual prognosis. The aim of the present study was to describe the epidemiological, clinical profile and visual outcomes (VO) predictors in patients with EE in a referral ophthalmology center. Methods : Retrospective, observational clinical study. Patients diagnosed with EE between January 2018 to September 2021 were included. Data collected included demographic characteristics, endophthalmitis origin, culture samples, microbiological diagnosis, initial and final best corrected visual acuity (BCVA), and treatment received. Major outcome was change in BCVA after endophthalmitis treatment and associated factors. T-test and Fisher's exact test for statistical analysis were used. Results : Seventy-three patients with EE were included. Surgery associated (SA) was the most common cause responsible for 39 cases (53.4%), followed by keratitis associated 18 cases (24.6%) and trauma associated (TA) 16 cases (21.9%). Gram-positive bacteria predominated in positive cultures (n= 35 [54.3%]). There was a statistically significant difference at mean age between TA group 41.1 ±18.7 years and SA group 59.9 ±20.9 years (p= 0.002). Final logMAR BCVA in the TA group was 4 ±0.9 (Snellen, light perception [LP]) and in the SA group was 2.7 ±1.7 (Snellen, Hand Motion [HM]). Fourteen (35.8%) patients in the SA group had a final BCVA ≥ 20/400;whereas in the TA group all patients had a final BCVA ≤ CF. Risk factors for non-improving BCVA after EE included OGT (p= 0.007) and initial BCVA of LP or worse (p <0.0001) in the SA group. There was no statistical difference in the final VO in patients that were treated with intravitreal injection (II) and those treated with vitrectomy (VTM) (p =0.40). Although 6 patients (75%) treated with VTM had an improvement in final BCVA compared with 12 (57.1%) of the patients just treated with II, this could be due to the sample number. We observed a tendency of diminishing cases of TA endophthalmitis after covid era, this could be associated with the isolation measures recommended. Conclusions : Surgery associated EE had a better visual prognosis than those with trauma associated EE. The initial BCVA is a meaningful indicator for final VO, being favorable when is better than HM.
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Purpose : With the recent emergence and worldwide distribution of COVID-19 vaccines, many side effects may be underreported and possibly unknown. Cases of vaccine-associated uveitis have been linked to almost all vaccines administered in the past, however, there is scarcity of literature providing insight into post COVID-19 vaccine associated uveitis / episcleritis. By documenting patients presenting with uveitis / episcleritis after the administration of mRNA Pfizer and Moderna vaccines, this case series significantly advances our current understanding of potential COVID-19 vaccine ocular complications. Methods : Patients with ocular symptoms consistent with uveitis / episcleritis within 15 days of the administration of the Pfizer or Moderna COVID-19 vaccine were included in this study. Ocular assessment included a Snellen best-corrected visual acuity (BCVA) converted to logMAR, intraocular pressure (IOP) with Goldmann Applanation Tonometry, pupil check, anterior and dilated posterior segment assessment with slit-lamp, and optical coherence tomography (OCT) imaging. Patients were anonymized and demographics including sex, race, age, and other necessary clinical data were recorded. Results : A total of 9 patients (6 female and 3 males) with a mean age of 42.9 (range, 19-83) were included. 7 patients received a Pfizer vaccine and 2 received a Moderna vaccine. 5 patients presented with symptoms after their first dose, 2 after their second dose, and 1 after both doses. The mean time of ocular symptoms post vaccine was 6.15 days (range, 1-14) and the mean BCVA was 0.657. Patients were diagnosed with bilateral anterior granulomatous uveitis (case 1), unilateral nongranulomatous anterior uveitis (case 2, 6-9), bilateral nongranulomatous anterior uveitis (case 3-4), and episcleritis (case 5). Case 1 and 9 have been highlighted and summarized in figure 1 and 2, respectively. Conclusions : The pathogenesis of vaccine induced uveitis is not properly understood, however, the outcomes of this case series aids in establishing a temporal association between the Pfizer and Moderna COVID-19 vaccines and the onset of uveitis / episcleritis. As the rate of COVID-19 vaccinations increase globally, it is imperative for physicians to be aware of the possible association and presentation of these ocular findings and diagnoses to effectively treat patients.
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Purpose : Although the ICL is more invasive than laser-assisted in situ keratomileusis (LASIK), it is indicated for patients with very high myopia, commonly over -7D. ICL is associated with certain risks including cataract and glaucoma which may develop years after surgery requiring additional procedures. In this study, we examined the outcome and safety profile of ICL vs. LASIK at 1 week, 1 month, and 1 year postoperatively. Methods : In this retrospective study, we examined records from a single surgeon (KK) as well as 2 patients with post ICL complications requiring ICL removal. An important aim of this study was to use the 1 year follow up data since this is one of the standard ICL follow up visits. We hypothesized that the FDA approved ICL (2005) would have a comparable target refractive outcome and safety profile when compared to LASIK. Results : There were a total of 45 ICL eyes and 65 LASIK eyes. Preoperatively, ICL patients had a significantly higher manifest refraction spherical equivalent (MRSE) and cycloplegic refraction spherical equivalent (CRSE) than LASIK patients (p<0.05). For patients who received the ICL implants, the average MRSE at 1-week, 1-month, 1-year post-op was -0.37D±(0.13), -0.29D±(0.09), -0.53D±(0.15);and -1.60D±(0.16), -0.36D±(0.15), -0.36D±(0.07) for patients who received LASIK. The differences in post-op MRSE between ICL and LASIK were not statistically significant (p>0.05). The only significant differences were 1 month LogMAR best corrected visual acuity and 1 year LogMAR distance uncorrected visual acuity (p<0.05), in which LASIK had better visual acuity. Common postoperative findings in both groups were refractive target deviations and punctate keratitis. Reoperation rates in the ICL and LASIK groups were 21.4% and 10.8% respectively, which was not statistically significant (p>0.05). 42.6% of ICL patients underwent the procedure during the COVID-19 pandemic compared to 26.2% of LASIK. Conclusions : Our results demonstrate that ICL is safe and effective for patients with high myopia. Although ICL patients had a significantly higher preoperative MRSE compared to the LASIK group, the ICL patients were able to achieve similar refractive targets. There were no cases of glaucoma or cataract at 1 year in the ICL group. In conclusion, ICL surgery is as safe and effective as LASIK surgery in correcting patients with high myopia, regardless of pre-operative refractive error.
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Purpose : During the COVID-19 pandemic, in line with the UK Royal College of Ophthalmologists' (RCOphth) guidelines, anti-VEGF treatment regimens for Neovascular Age Related Macular degeneration (nAMD) were adjusted to 8 weekly Aflibercept injections with no clinic review. New patients and those who mentioned a significant drop of vision during their injection visits had OCT and their management adjusted to 4 weekly injections. This work audits our practice at a tertiary university hospital during the 2020 pandemic. Methods : Retrospective electronic data was collected from the Medisoft ophthalmology database for patients with nAMD, who received Aflibercept over a 5 month period from 01.03.2020 to 01.08.2020. Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CRT), and number of injections were collected, and compared with our previously published year one data of 225 treatment naïve eyes of 223 patients with nAMD, treated with 8 weekly Aflibercept with mean BCVA of 61 letters & mean CRT of 235 μm at month 5 of therapy. We also assessed the clinical outcomes of our patients who received 4 weekly Aflibercept injections. Statistical analysis was done using SPSS version 24. Results : 1778 eyes of 1427 patients met the inclusion criteria and were included in the study. 1338 patients (93.8%) received 8 weekly injections, their mean BCVA ± SD was 59.7 ± 17.3 with CRT of 239.3 μm ± 67.2 SD at baseline and their latest BCVA ± SD was 59.3 ± 17.4, with CRT of 231.8 μm ± 73.8 SD. More than one third of them 618 (43.3%) received three injections during that period. 89 of our patients (6.2%) received 4 weekly injections during our study period. Their mean BCVA ± SD was 60.5 ± 17.6 with CRT of 276.1 μm ± 96.4 SD at baseline and their latest BCVA ± SD was 62.3 ± 15.1, with CRT of 247.8 μm ± 49.0 SD. Conclusions : Reassuringly, during the COVID-19 pandemic, patients on a fixed 8 weekly Aflibercept pathway maintained their vision. Their mean BCVA & CRT were comparable to our pre-COVID audit outcomes with a treat and extend protocol. Patients on 4 weekly injections also maintained their vision during the pandemic. RCOphth COVID guidelines allowed AMD patients to receive effective therapy whilst minimizing time in hospitals and permitted ophthalmologists to do other COVID related tasks.
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Purpose : To investigate the effect of online learning and other environmental factors on myopia progression during the COVID-19 pandemic. Methods : A retrospective, cohort study on children aged from 6 to 14 years with myopia. Data were gathered from 3 visits;pre-COVID 19, at the beginning of the pandemic, and during the pandemic. Patients' demographics (number of hours spent on screens for educational and recreational purposes, type of screen used, and number of hours spent outdoors), best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and cycloplegic refraction to quantify spherical equivalent (SE) were measured for all participants. Progression of myopia was calculated based on difference between the three visits. Results : One hundred and fifty patients met our inclusion criteria. Mean age was 11±2.4 years. There were 70 males (47%). They mainly used mobile phones (62%) and had insufficient outdoor play (88%). Out of 300 eyes, 221 (74%) had progression in myopia. A significant difference was found in SE between pre-COVID-19 (-0.29 ±0.23) and post-COVID-19 (-0.40 ±0.11) with a p-value of 0.023. Additionally, UCVA showed difference between the initial Vs. 1st follow-up visit (0.57±0.37 vs 0.64±0.36, p-value =0.001), and first follow-up visit Vs. 2nd follow-up visit (0.64±0.36 vs 0.70±0.36, p-value =0.001). Survival analysis showed significant hazard ratio on change in SE for high age group (>9 years), (HR [95% CI], 0.71 [0.51-0.84]), recreational screen usage (HR [95% CI], 1.26 [1.15-1.66]) and insufficient outdoor time (HR [95% CI], 1.45 [1.35-1.67]). Conclusions : Myopia progression was accelerated compared to pre-COVID-19 times in terms of spherical equivalent. Younger age group, prolonged screen users and insufficient outdoor time contributed to the further increase in myopia. However, the type of device had no effect statistically on the progression of myopia.
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Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was declared a pandemic by the World Health Organization on 11 March 2020 has been reported in most countries around the world since its origins in Wuhan, China. As of September 2021, there have been over 229 million cases of COVID-19 reported worldwide, with over 4.7 million COVID-19–associated deaths. Body: The devastating second wave of the COVID-19 pandemic in India has seen a rise in various extrapulmonary manifestations. One of key components in the pathogenesis of COVID-19 is downregulation of ACE-2, which is expressed on many organs and counterbalances the pro-inflammatory effects of ACE/angiotensin-II axis. This leads to influx of inflammatory cells into alveoli, increased vascular permeability and activation of prothrombotic mediators. Imaging findings such as ground glass opacities, interlobular septal thickening, vascular dilatation and pulmonary thrombosis correlate well with the pathogenesis. Conclusion: We hypothesize that the systemic complications of COVID-19 are caused by either direct viral invasion or effect of cytokine storm leading to inflammation and thrombosis or a combination of both. Gaining insights into pathobiology of SARS-CoV-2 will help understanding the various multisystemic manifestations of COVID-19. To date, only a few articles have been published that comprehensively describe the pathophysiology of COVID-19 along with its various multisystemic imaging manifestations.
ABSTRACT
Background: In response to the coronavirus disease-2019 (COVID-19) pandemic, routine clinical visits to the ophthalmic emergency department (OED) were deferred, while emergency cases continued to be seen. Objectives: To assess the consequences of the COVID-19 pandemic for ophthalmic emergencies. Methods: A retrospective chart analysis of patients who presented to the OED during the peak of the COVID-19 pandemic was conducted. The proportions of traumatic, non-traumatic-urgent, and non-traumatic-non-urgent presentations in 2020 were compared to those of the same time period in 2019. Duration of chief complains and best-corrected visual acuity were also assessed. Results: There were 144 OED visits in 2020 compared to 327 OED visits during the same 3-week-period in 2019. Lower mean age of OED patients was present in 2020. Logarithmic expression (LogMAR) best corrected visual acuity (BVCA) was similar in both years. In 2020 there was a reduction in traumatic, non-traumatic-urgent, and non-traumatic-non-urgent cases compared to 2019 (15.4% reduction, P= 0.038;57.6% reduction, P= 0.002;74.6% reduction, P= 0.005, respectively). There was a higher proportion of same-day presentations at commencement of symptoms in 2020 compared with 2019 (52.8% vs. 38.8%, respectively P= 0.006). Conclusions: During the COVID-19 pandemic, the number of OED visits at a tertiary hospital dropped by more than half. Although the drop in visits was mostly due to decrease in non-traumatic-non-urgent cases, there was also decrease in non-traumatic-urgent presentations with possible important visual consequences. Additional studies should elucidate what happened to these patients.
ABSTRACT
Purpose: Visual impairment has a significant negative impact on quality of life, independence and ability to work. This study quantifies the prevalence of undiagnosed visual impairment detected at pop-up community screening clinics in the Waikato region of New Zealand. Locations were selected to target vulnerable populations including elderly Māori that may not otherwise attend vision assessments elsewhere. Methods: Pop-up screening clinics were completed at two locations: regional marae performing COVID-19 vaccinations and at a local retirement home. Best corrected visual acuity (BCVA) and autorefraction was measured. Individuals were flagged for community follow-up if BCVA was better than 6/12 or hospital follow-up if BCVA was worse than 6/12 bilaterally or 6/15 in either eye. All individuals 40 years or older were invited to participate in the vision screening. Results: In total 64 individuals were screened with 59% females. Ethnicities included Māori (44%), New Zealand-European (34%) and undeclared (22%). Average age was 69.74 years. Based on BCVA, 59% were flagged for community follow-up and 41% for hospital follow-up. Of the 26 referred for hospital follow-up, 69% have been reviewed. Diagnosed pathology included: cataract (55%), age-related macular degeneration (17%), other (17%), and refractive error (11%). Conclusion: This pilot study reports high rates of undiagnosed ocular pathology. Obtaining accurate prevalence data on visual impairment in vulnerable populations is important for developing service delivery models to provide timely treatment for these populations. This pilot highlights barriers to access public funded ophthalmic care for vulnerable populations using the existing models of healthcare delivery.