Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Angiogenesis Inhibitors/adverse effects , Endophthalmitis/diagnosis , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/etiology , Humans , Incidence , Intravitreal Injections , Masks/adverse effects , Retrospective StudiesABSTRACT
A central retinal vein occlusion (CRVO) case in a patient developed with sudden blurred vision in some hemifield areas of his left eye, maintaining 20/20 vision 15-days after the COVID-19 vaccination. Initial retinal findings were venous dilation and tortuosity with dispersing dot hemorrhages. Fluorescein angiography (FA) and optical coherence tomography (OCT) confirmed a non-ischemic CRVO diagnosis, and a complete blood panel was requested with average results. An intravitreal steroid dose was applied. A decrease in best-corrected visual acuity (BCVA) (20/30) with more intraretinal hemorrhages was documented. An intravitreal dose of bevacizumab and oral apixaban were added with a final BCVA of 20/20 with decreased hemorrhages. There is no specific causal relationship between COVID-19 vaccines and CRVO. Without previous risk factors and positive treatment response, this case may correlate the first COVID-19 vaccine dose and the event.
Subject(s)
COVID-19 , Macular Edema , Retinal Vein Occlusion , Angiogenesis Inhibitors/adverse effects , Bevacizumab/adverse effects , COVID-19 Vaccines , Fluorescein Angiography , Humans , Intravitreal Injections , Macular Edema/drug therapy , RNA, Messenger , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/drug therapy , Retinal Vein Occlusion/etiology , SARS-CoV-2 , Tomography, Optical Coherence , Treatment Outcome , Vaccination/adverse effects , Visual AcuityABSTRACT
BACKGROUND: Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID-19 pandemic, in order to minimize the risk of disease transmission. METHOD: We performed probability calculations to estimate COVID-19 infection status and likelihood of disease transmission among neovascular age-related macular degeneration patients and health-care workers during anti-VEGF procedures, at various community prevalence levels of COVID-19. We then applied the expected burden of COVID-19 illness and death expressed through health-adjusted life-years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti-VEGF injections were not performed. RESULTS: Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID-19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID-19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5-43%). CONCLUSION: Unless COVID-19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID-19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.