ABSTRACT
Background: Currently, the present world is facing a new deadly challenge from a pandemic disease called COVID-19, which is caused by a coronavirus named SARS-CoV-2. To date, no drug or vaccine can treat COVID-19 completely, but some drugs have been used primarily, and they are in different stages of clinical trials. This review article discussed and compared those drugs which are running ahead in COVID-19 treatments. Method(s): We have explored PUBMED, SCOPUS, WEB OF SCIENCE, as well as press releases of WHO, NIH and FDA for articles related to COVID-19 and reviewed them. Result(s): Drugs like favipiravir, remdesivir, lopinavir/ritonavir, hydroxychloroquine, azithromycin, ivermectin, corticosteroids and interferons have been found effective to some extent, and partially approved by FDA and WHO to treat COVID-19 at different levels. However, some of these drugs have been disapproved later, although clinical trials are going on. In parallel, plasma therapy has been found fruitful to some extent too, and a number of vaccine trials are going on. Conclusion(s): This review article discussed the epidemiologic and mechanistic characteristics of SARS-CoV-2, and how drugs could act on this virus with the comparative discussion on progress and drawbacks of major drugs used till date, which might be beneficial for choosing therapies against COVID-19 in different countries.Copyright © 2022 Bentham Science Publishers.
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Purpose : In recent years, innovations in tele-ophthalmology have shown promise in providing quality ophthalmic care to patients in low-access settings and high-risk environments such as the COVID-19 pandemic. Emergency departments and urgent centers may benefit from tele-ophthalmology applications;the tele-images can be sent to the covering ophthalmologist or, to another ED for evaluation of images prior to transferring the patient. In this study, we aimed to assess the ability of resident physicians to identify features of posterior-pole retinal pathology using teleophthalmology. Methods : Retrospective study on 16 patients (32 eyes;30 with retinal pathology and 2 controls) who presented to a retina clinic at an academic medical center. Automated OCT-B images with 3D topographic maps and fundus photographs of the posterior pole using a Topcon Maestro 3D OCT-1 unit were taken. Images were transmitted remotely to a resident physician who attempted to identify retina pathology using fundus photography and OCT. The same images were consequently evaluated by a retina specialist for grading. We then tested the concordance between diagnoses rendered via tele-OCT by the resident physician and the gold standard clinical examination (performed by the retina specialist) using Cohen's Kappa statistic (κ). Results : An overall average of 79.9% concordance for 69 potential findings was obtained between the retina attending's diagnosis with clinical examination and the resident physician's diagnosis using tele-OCT/fundus images based on Cohen's Kappa statistic (κ). The concordance was lower in eyes with vitreous hemorrhage most likely due to the inferior quality fundus and OCT-B images. The resident exam also identified the presence of any macular pathology in all 30 eyes with macular pathology and correctly identified the controls, indicating 100% sensitivity for identifying abnormal findings using tele OCT/fundus images. Conclusions : This study verifies the utility of resident screening of tele-OCT fundus and OCT-B images to identify retinal pathology. Tele-ophthalmology likely has a useful role in triaging retinal pathology whose outcomes could be affected by timely intervention. Many unnecessary emergency transfers may be avoided if the on-call ophthalmology residents are able to review the fundus and OCT images before hand.
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Purpose : Understanding of the ocular manifestations of coronavirus disease 2019 (COVID-19) is continuing to develop. While ocular symptoms, chiefly conjunctivitis, have been reported, retinal pathologies have been suggested as a rarer complication and are hypothesized to derive from a combination of the inflammatory and vasculopathic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Using a retrospective, observational case series design, we describe a series of four eyes in three patients with acute macular neuroretinopathy (AMN) and paracentral acute middle maculopathy (PAMM) associated with COVID-19 illness. Methods : Our practice's electronic medical record (EMR) was retrospectively queried for patients from April 2020 to December 2021 who had been diagnosed with AMN or PAMM and COVID-19 illness. Three patients were identified by this method. Patient demographic information, physical exam, optical coherence tomography (OCT), infrared reflectance (IR), and fluorescein angiography (FA) studies were all used for analysis. Results : Imaging signs of AMN were revealed in four eyes in three female patients, aged 22, 32, and 64 years old, all with confirmed symptomatic COVID-19 corresponding to the start of visual symptoms. The average onset of visual symptoms from COVID-19 illness was 14 days (range 0-56). 4/4 eyes were symptomatic for scotomata. Average logMAR visual acuity was 0.024 (Snellen 20/21, range 0-0.097). 4/4 eyes demonstrated typical findings of AMN: IR imaging with prominent dark petaloid or ovoid parafoveal lesions and corresponding disruption of the ellipsoid zone on OCT (Fig. 1). FA imaging did not show any abnormal fluorescence pattern. Autofluorescence in 1/4 eyes demonstrated hyperautofluorescence corresponding to the abnormal area on IR imaging (Fig. 2). Two month follow-up showed persistent symptoms of scotomata with unchanged findings on follow-up imaging in 100% of cases. Conclusions : This series demonstrates that, although rare, SARS-CoV-2 infection may result in microvasculopathic injuries to the retina, namely AMN and PAMM. (Figure Presented).
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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 : COVID-19 vaccination has been accompanied by reports of inflammatory events. We aim to report the first case of bilateral persistent placoid maculopathy (PPM) following COVID-19 vaccination. Methods : Case report Results : A 58-year-old man presented with bilateral sudden painless decrease in vision approximately two weeks after the second dose of AstraZenaca® COVID-19 vaccine. Visual acuity (VA) at presentation was 1.00 LogMAR in the right eye (RE) and hand movement in the left eye (LE). He had no known medical or ophthalmic history, up until after his first AstraZenaca® COVID-19 vaccine dose, he was diagnosed with palmoplantar pustular psoriasis and was started on 60mg of oral Prednisolone. Fundus examination revealed bilateral well-delineated whitish plaque-like macular lesions involving the fovea, sparing the peripapillary region in the RE (Figure 1a & e). Multimodal imaging including fluorescein angiography, indocyanine-green angiography, fundus autofluorescence and optical coherence tomography were consistent with PPM (Figure 1 & 2). Infective and auto-immune screen were all negative apart from a positive MPO-ANCA, prompting a rheumatology review which subsequently excluded any systemic vasculitis. Patient was monitored closely and his VA improved and stabilised with tapering regime of oral Prednisolone. To prevent relapse of PPM, patient was commenced on Mycophenolate Mofetil as a long-term steroid sparing immunosuppression. Conclusions : Our case demonstrated a likely inflammatory or autoimmune response affecting choriocapillaris driven by the COVID-19 vaccine and there may be a correlation between the two. The patient in our case portrayed features classical of PPM, which is a selective autoimmune vasculitis causing microinfarcts on choriocapillaris, resulting in focal choroidal hypoperfusion after the COVID-19 vaccine. (Figure Presented).
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CASE: A 48-year-old female with no medical history presented with 2 days of decreased vision in the right eye. She reported painless blurry vision that progressed to near complete vision loss. The vision loss was accompanied by one month of progressively worsening cough, body aches, and subjective fevers. She denied smoking and reported no sick contacts. Physical exam was notable for submandibular lymphadenopathy, bilateral conjunctival injection, and grossly decreased vision of the right eye. She also endorsed decreased sensation in bilateral lower extremities distally. Her initial labs showed leukocytosis (13), thrombocytosis (754), and elevated inflammatory markers (ESR 105 and CPR 359). A chest CT showed bilateral upper lobe consolidations and scattered mass like opacities bilaterally. Ophthalmic exam of the right eye revealed multiple small retinal infarctions consistent with paracentral acute middle maculopathy. A CT head was negative and TTE showed no vegetation. Additional testing revealed negative TB, COVID, and normal complements. Initial ANCA testing was negative, however a repeat test was strongly positive for ANCA with PR3 significantly elevated to 428. She was diagnosed with granulomatosis with polyangiitis (GPA) vasculitis and treated with prednisone and started induction therapy of Rituximab. IMPACT/DISCUSSION: GPA is a small-medium vessel necrotizing vasculitis and the most common anti-neutrophil- cytoplasmic-antibody (ANCA) associated vasculitis. GPA classically involves the upper respiratory tract, lungs, and kidneys referenced by the ELK criteria (ENT, Lung, Kidney) commonly used for diagnosis. ENT findings are present in 70-100% of cases with the nasal cavity and paranasal sinuses most commonly involved. Roughly 50% have pulmonary involvement on presentation, as in this patient, while only 10-20% have initial renal involvement. A prodrome of systemic symptoms including body aches and fevers is often present. GPA is closely associated with c-ANCA, with autoantibodies to proteinase 3 (PR3) positive in over 80% of cases. This patient did have prodromal symptoms yet her primary presenting symptom of vision loss was atypical. Eye involvement is not part of the diagnostic triad yet it can occur in GPA. When it does present, it usually manifests as scleritis, conjunctivitis, or uveitis. Retinal infarctions, as seen in this patient, are uncommon and make this case an atypical presentation of GPA. Additionally, ANCA positivity is related to disease activity and a negative ANCA should not exclude GPA from a differential. Not all patients will be ANCA positive on initial presentation and 10% of patients with GPA will remain ANCA negative. CONCLUSION: Providers should consider atypical presentations of GPA in addition to the classic triad of ENT, Lungs, and Kidneys. Renal manifestations are often missing initially and involvement of other systems, such as ocular, can take place. With a positive c-ANCA and high clinical suspicion, treatment should not be delayed.