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1.
PLoS One ; 16(11): e0259142, 2021.
Article in English | MEDLINE | ID: covidwho-1511824

ABSTRACT

PURPOSE: The aim of this cohort study was to evaluate the development and progression of presbyopia and the status of dry eye-related symptoms from 2017 to 2020, to assess the impact of the COVID-19 pandemic. METHODS: Near add power at 30 cm was measured in 339 participants aged between 40 and 55 from 2017 to 2021 at Japanese eye clinics. Regression analysis of near add power and age was analyzed to compare 2017 with later years up to the pandemic. The prevalence of dry eye-related signs and six common symptoms were compared. RESULTS: The number and mean age (y) of participants were 183 (48.6±4.1) in 2017, 46 (51.3±7.5) in 2019, and 110 (49.2±3.7) in 2020-21, respectively. The mean progression rate of near add power (D/y) was 0.13 for 2017, 0.09 for 2019 (P = 0.028, vs 2017), and 0.08 for 2020-21 (P<0.001, vs 2017). The slope (rate of presbyopia progression) became flatter from 2017 to 2021 and the estimated near add power at the age of 40 increased from 2017 to 2020-2021, implicating presbyopia developed earlier and worsened during the study period. The 2017 values were comparable with previous studies described in 1922 and 2019. The standardized correlation coefficient between age and near add power was 0.816 for 2017, 0.671 for 2019 (P = 0.084, vs 2017), and 0.572 for 2020-21 (P<0.001, vs 2017). Multiple regression analysis revealed age and COVID-19 pandemic were significantly correlated with near add power. The prevalence of dryness irritation, and pain was greater in 2020-21 than in 2017 with no difference in the prevalence of eye fatigue, blurring, and photophobia. There was no difference in the prevalence of short tear break-up time and positive corneal staining among 2017, 2019 and 2020-21. CONCLUSION: Estimated presbyopia developed earlier and progressed slower from 2017 to 2021, the COVID-19 pandemic. Stress and rapid digitalization related to strict infection control and quarantine might be contributing factors.


Subject(s)
COVID-19/epidemiology , Dry Eye Syndromes/epidemiology , Pandemics , Presbyopia/epidemiology , Adult , COVID-19/complications , COVID-19/virology , Cohort Studies , Dry Eye Syndromes/complications , Dry Eye Syndromes/virology , Female , Humans , Japan/epidemiology , Male , Middle Aged , Presbyopia/complications , Presbyopia/virology , Refraction, Ocular/physiology , SARS-CoV-2/pathogenicity , Visual Acuity/physiology
2.
Retina ; 41(4): 701-705, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1511061

ABSTRACT

PURPOSE: To describe our managing strategy for COVID-19 emergency, to evaluate the adherence to intravitreal treatment (AtT) rate during the outbreak in a referral hospital in Milan, and to correlate it with patients' clinical features. METHODS: The AtT rate of patients with scheduled intravitreal injections during the COVID-19 outbreak from February 23, 2020 to March 31, 2020 was compared with the previous trimester and with March 2019. The impact of age, sex, visual function, and diagnosis on the AtT rate during unlocked/locked weeks (from March 8th) was evaluated. RESULTS: Of 650 consecutive patients with scheduled intravitreal injections, the AtT rate during the COVID-19 outbreak was 0.37. This was significantly lower compared with AtT registered in the previous trimester (0.92) and in the same weeks in 2019 (0.90) (both P < 0.001). Patients adherent to treatment were significantly younger (P < 0.001) and had a lower best-corrected visual acuity in the fellow eye (P = 0.046). During the lockdown weeks, the AtT rate was significantly lower than in the two unlocked weeks (0.19 vs. 0.73, P < 0.001). In addition, the AtT rate in patients classified as "emergent" during the lockdown weeks was 0.60. CONCLUSION: These preliminary results can help the retina specialist community to foresee this unique scenario and to develop successful management strategies.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Appointments and Schedules , COVID-19/epidemiology , Choroidal Neovascularization/drug therapy , Macular Edema/drug therapy , SARS-CoV-2 , Wet Macular Degeneration/drug therapy , Aged , Aged, 80 and over , COVID-19/transmission , Choroidal Neovascularization/diagnostic imaging , Choroidal Neovascularization/physiopathology , Communicable Disease Control/methods , Female , Fluorescein Angiography , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intravitreal Injections , Italy/epidemiology , Macular Edema/diagnostic imaging , Macular Edema/physiopathology , Male , Referral and Consultation/statistics & numerical data , Tomography, Optical Coherence , Visual Acuity/physiology , Wet Macular Degeneration/diagnostic imaging , Wet Macular Degeneration/physiopathology
3.
Cornea ; 41(1): 121-124, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1462537

ABSTRACT

PURPOSE: The purpose of this report was to describe 4 cases of acute corneal transplant rejection occurring in association with coronavirus disease 2019 (COVID-19) mRNA vaccination. METHODS: Four patients with prior keratoplasty developed presumed immunologic rejection after the mRNA-1273 vaccination for coronavirus 2 (SARS-CoV-2). Case 1 had received Descemet membrane endothelial keratoplasty 6 months ago and presented with endothelial graft rejection 3 weeks after the first vaccine dose. Case 2 had undergone penetrating keratoplasty 3 years previously and presented with acute endothelial rejection 9 days after the second vaccine dose. Case 3 had prior Descemet stripping automated endothelial keratoplasty (DSAEK) and began experiencing symptoms of endothelial graft rejection 2 weeks after the second vaccine dose. Case 4 presented with endothelial rejection of the penetrating keratoplasty graft 2 weeks after the second vaccine dose. RESULTS: Frequent topical corticosteroids alone were initiated in all 4 cases. In case 1, the endothelial rejection line appeared fainter with improvement in visual acuity and corneal edema 5 weeks after diagnosis. Case 2 experienced complete resolution of corneal stromal edema and rejection line 6 weeks after diagnosis. Cases 3 and 4 have both experienced initial improvement with steroid treatment as well. CONCLUSIONS: These cases suggest acute corneal endothelial rejection may occur soon after either dose of the COVID-19 mRNA vaccine. Prompt initiation of aggressive topical steroid therapy may result in complete resolution of clinical signs and symptoms. Further studies are needed to elucidate the causal mechanism of corneal graft rejection after COVID-19 vaccination.


Subject(s)
/adverse effects , COVID-19/prevention & control , Descemet Stripping Endothelial Keratoplasty , Graft Rejection/etiology , Keratoplasty, Penetrating , SARS-CoV-2 , Vaccination/adverse effects , Acute Disease , Aged , Corneal Diseases/surgery , Female , Graft Rejection/diagnosis , Graft Rejection/drug therapy , Humans , Male , Middle Aged , Visual Acuity/physiology
4.
Cornea ; 40(11): 1502-1504, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1328949

ABSTRACT

ABSTRACT: The coronavirus disease 2019 global pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several ophthalmic manifestations have been reported to be associated with SARS-CoV-2 infection, including conjunctivitis, acute sixth nerve palsy, and multiple cranial neuropathies. We present a unique case of unilateral phlyctenular keratoconjunctivitis in a 5-year-old boy in the setting of SARS-CoV-2 infection.


Subject(s)
COVID-19/diagnosis , Conjunctivitis, Viral/diagnosis , Eye Infections, Viral/diagnosis , Keratoconjunctivitis/diagnosis , SARS-CoV-2/pathogenicity , Administration, Oral , Anti-Bacterial Agents/administration & dosage , Ascorbic Acid/administration & dosage , Azithromycin/administration & dosage , COVID-19/drug therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Child, Preschool , Conjunctivitis, Viral/drug therapy , Conjunctivitis, Viral/virology , Drug Therapy, Combination , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Fluorometholone/therapeutic use , Glucocorticoids/therapeutic use , Humans , Keratoconjunctivitis/drug therapy , Keratoconjunctivitis/virology , Male , Ophthalmic Solutions , Slit Lamp Microscopy , Tomography, Optical Coherence , Visual Acuity/physiology
5.
Cornea ; 40(4): 477-483, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1262261

ABSTRACT

PURPOSE: This is a cohort study to evaluate the presence of objective signs and subjective symptoms of dry eye disease in postcoronavirus disease 2019 (COVID-19) patients compared with the control. METHODS: Prospective, observational, single-ctenter, cohort study. Sixty-four post-COVID-19 patients and 50 control were recruited. All participants underwent a complete ophthalmological examination including Ocular Surface Disease Index Questionnaire (OSDI), best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, Schirmer test type 1, tear break-up time test (tBUT), evaluation of conjunctival hyperemia, corneal staining, and tear film osmolarity test. RESULTS: The OSDI score was higher in the post-COVID-19 group in the quantitative and qualitative analysis (P < 0.001 and P =0.012, respectively). The mean tBUT in post-COVID-19 patients was 6.95 ± 4.07 seconds compared with a mean tBUT of 10.12 ± 3.90 seconds in the control group. The post-COVID-19 group showed a higher number of patients with a simultaneous impairment of the OSDI score and tBUT (P = 0.019). The Schirmer test results were strikingly significant both in the quantitative analysis and qualitative analysis (P <0.001 and P = 0.0014, respectively). Both quantitative analysis and qualitative analysis revealed a significant difference in tear osmolarity in the 2 groups. CONCLUSIONS: Comparing the ocular surface assessment of post-COVID-19 patients with heathy control, a statistically significant increase of dry eye disease has emerged both in subjective and objective evaluations. Our clinical results support the findings that suggested a susceptibility of the ocular surface to the virus, and it underlines the importance of the ocular surface assessment in post-COVID-19 patients for a correct diagnosis and therapy.


Subject(s)
COVID-19/complications , Dry Eye Syndromes/etiology , SARS-CoV-2/isolation & purification , Adult , Aged , COVID-19 Serological Testing , Cohort Studies , Diabetes Mellitus/diagnosis , Diabetes Mellitus/etiology , Dry Eye Syndromes/diagnosis , Female , Humans , Male , Middle Aged , Osmolar Concentration , Prospective Studies , Pulmonary Arterial Hypertension/diagnosis , Pulmonary Arterial Hypertension/etiology , Slit Lamp Microscopy , Tears/chemistry , Tears/physiology , Visual Acuity/physiology
6.
Am J Case Rep ; 22: e931169, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1209498

ABSTRACT

BACKGROUND Retinal sequelae have been reported in patients who have had COVID-19. This is a case report of acute macular neuroretinopathy (AMN), presenting with low visual acuity in the left eye, 14 days after the first symptoms of COVID-19 infection. CASE REPORT A 71-year-old woman presented for ophthalmological evaluation complaining of low visual acuity in the left eye, 14 days after the first symptoms of COVID-19 infection. COVID-19 was confirmed by a reverse-transcription polymerase chain reaction (RT-PCR) test. The left eye examination showed visual acuity of 0.5 logMAR, fundoscopy showed foveal pigment mobilization, fluorescein angiography revealed a hypofluorescent fovea surrounded by irregular hyperfluorescent defects, and spectral-domain optical coherence tomography showed central foveal thinning with disrupted interdigitation and ellipsoid zones. Given the clinical and imaging findings, the diagnosis of AMN was finalized. AMN usually resolves without specific treatment. CONCLUSIONS This case report shows that patients with COVID-19 can develop retinal involvement. AMN can be due to a viral infection, including COVID-19, and usually resolves without specific treatment. In the present case, there was no improvement in the patient's clinical condition in a 2-month follow-up to date.


Subject(s)
COVID-19 , Visual Acuity , White Dot Syndromes , Aged , COVID-19/complications , COVID-19/diagnosis , Female , Humans , Visual Acuity/physiology , White Dot Syndromes/virology
7.
Br J Ophthalmol ; 105(7): 893-896, 2021 07.
Article in English | MEDLINE | ID: covidwho-1207486

ABSTRACT

AIM: We report two cases of endothelial corneal allograft rejection following immunisation with SARS-CoV-2 messenger RNA (mRNA) vaccine BNT162b2 and describe the implications for management of transplant recipients postvaccination for COVID-19. METHODS: A 66-year-old woman with Fuchs endothelial corneal dystrophy (FECD) and a unilateral Descemet's membrane endothelial keratoplasty (DMEK) transplant received COVID-19 mRNA vaccine BNT162b2 14 days post-transplant. Seven days later, she presented with symptoms and signs of endothelial graft rejection. An 83-year-old woman with bilateral DMEK transplants for FECD 3 and 6 years earlier developed simultaneous acute endothelial rejection in both eyes, 3 weeks post second dose of COVID-19 mRNA vaccine BNT162b2. Rejection in both cases was treated successfully with topical corticosteroids. CONCLUSIONS: We believe this is the first report of temporal association between corneal transplant rejection following immunisation against COVID-19 and the first report of DMEK rejection following any immunisation. We hypothesise that the allogeneic response may have been initiated by the host antibody response following vaccination. Clinicians and patients should be aware of the potential of corneal graft rejection associated with vaccine administration and may wish to consider vaccination in advance of planned non-urgent keratoplasties. Patients should be counselled on the symptoms and signs that require urgent review to allow early treatment of any confirmed rejection episode.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Descemet Stripping Endothelial Keratoplasty , Endothelium, Corneal/pathology , Graft Rejection/etiology , Immunization/adverse effects , Administration, Ophthalmic , Aged , Aged, 80 and over , Allografts , Anterior Eye Segment/diagnostic imaging , COVID-19/genetics , Dexamethasone/therapeutic use , Endothelium, Corneal/diagnostic imaging , Female , Fuchs' Endothelial Dystrophy/surgery , Glucocorticoids/therapeutic use , Graft Rejection/diagnostic imaging , Graft Rejection/drug therapy , Humans , Intraocular Pressure/physiology , Microscopy, Confocal , Ophthalmic Solutions , RNA, Messenger/genetics , SARS-CoV-2/genetics , Slit Lamp Microscopy , Tomography, Optical Coherence , Visual Acuity/physiology
8.
Indian J Ophthalmol ; 69(4): 987-989, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1138817

ABSTRACT

A 42-year-old male patient presented with profound impairment of vision in both eyes, just as he was recovering from COVID-19. A known diabetic and hypertensive, he suffered from COVID-19 pneumonia further complicated by ARDS, septicaemia and acute kidney injury. His vision on presentation was finger counting close to face bilaterally with multiple, yellowish lesions at the posterior pole. Based on the clinical findings and previous blood culture report, it was diagnosed as candida retinitis and treated with oral and intravitreal anti-fungals. The lesions were regressing at follow-up. This is a post COVID-19 presumed candida retinitis case report.


Subject(s)
COVID-19/diagnosis , Candidiasis/diagnosis , Eye Infections, Fungal/diagnosis , Opportunistic Infections/diagnosis , Retinitis/diagnosis , SARS-CoV-2 , Administration, Oral , Adult , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Candidiasis/microbiology , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Fluconazole/therapeutic use , Humans , Intravitreal Injections , Male , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Retinitis/drug therapy , Retinitis/microbiology , Tomography, Optical Coherence , Visual Acuity/physiology , Voriconazole/therapeutic use
9.
Can J Ophthalmol ; 56(1): 24-30, 2021 02.
Article in English | MEDLINE | ID: covidwho-1065296

ABSTRACT

OBJECTIVE: To quantify the density of the macular microvasculature and the area of the foveal avascular zone (FAZ) in patients recovered from coronavirus disease 2019 (COVID-19) using optical coherence tomography angiography (OCTA) analysis. METHODS: In a comparative cross-sectional, observational study, patients recovered from COVID-19 were included in this study. All included subjects exhibited a reverse transcription-polymerase chain reaction-confirmed diagnosis of COVID-19. Spectral domain macular OCTA was performed at least 2 weeks after recovery from systemic COVID-19. Vessel density (VD) of the superficial (SCP) and deep retinal capillary plexus (DCP) and the area of the FAZ were measured in COVID-19 recovered patients versus age-matched normal controls. RESULTS: Thirty-one recovered COVID-19 patients and 23 healthy normal controls were studied. Mean quality scan index was 7.64 ± 0.66 in the COVID cases and 8.34 ± 0.71 in the normal controls (p = 0.001). Mean SCP VD and DCP VD of the COVID cohort were significantly lower than the SCP VD and DCP VD of the control group in the foveal and parafoveal regions. FAZ area was greater in the COVID cohort, but this difference was not statistically significant. In addition, in the COVID cohort, VD of the SCP was lower in patients with a history of COVID-19 hospitalization versus those without such a history, but this did not reach statistical significance. CONCLUSIONS: Patients recovered from COVID-19 displayed alterations in the retinal microvasculature, including a significantly lower VD in the SCP and DCP. Patients with coronavirus infection may be at risk of retinal vascular complications.


Subject(s)
COVID-19/physiopathology , Eye Infections, Viral/physiopathology , Retinal Diseases/physiopathology , Retinal Vessels/physiopathology , SARS-CoV-2 , Adult , COVID-19/diagnosis , COVID-19/virology , COVID-19 Nucleic Acid Testing , Case-Control Studies , Cross-Sectional Studies , Eye Infections, Viral/diagnostic imaging , Eye Infections, Viral/virology , Female , Fluorescein Angiography , Humans , Male , Microvessels , Middle Aged , Recovery of Function , Retinal Diseases/diagnostic imaging , Retinal Diseases/virology , Retinal Vessels/diagnostic imaging , Tomography, Optical Coherence , Visual Acuity/physiology
11.
Can J Ophthalmol ; 56(2): 88-95, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1027890

ABSTRACT

OBJECTIVE: To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the characteristics of retinal detachments (RD) at a tertiary centre. DESIGN: Retrospective consecutive case series. PARTICIPANTS: One hundred and ninety eyes of 188 patients with primary, rhegmatogenous RD. METHODS: Patients with RD who presented over a 1-year period (September 14, 2019 to September 13, 2020). The relationship between demographic, anatomic, and visual acuity parameters were compared before and after onset of the pandemic using generalized estimating equations. MAIN OUTCOME MEASURES: Macular status and corrected distance visual acuity on presentation. RESULTS: One hundred and eighty-seven eyes, divided into 2 cohorts: pre-COVID (n = 100 September 14, 2019 to March 13, 2020) and post-COVID (n = 87, March 14, 2020 to September 13, 2020). Of the eyes, 63.2% (n = 87) presented with macular detachment in the post-COVID group compared with 45% (n = 100) in the pre-COVID group (odds ration [OR], 2.14; 95% confidence interval [CI],1.19-3.86; p = 0.011). As well, eyes in the pre-pandemic cohort had significantly fewer detached quadrants on initial examination (OR, 0.53; 95% CI, 0.30-0.93; p = 0.026). Patients in the post-COVID group had a significantly worse corrected distance visual acuity at baseline (mean difference [MD] = -0.35 logMAR, 95% CI, -0.60 to -0.09; p = 0.008), but not at 1 month or at final follow-up. No differences were seen between groups with respect to demographics, lens status, treatment, time to presentation, or chronicity. Pneumatic retinopexy was the most commonly performed procedure in both cohorts, with a 71.5% success rate. CONCLUSIONS: Closures after the COVID-19 pandemic affected the characteristics of RDs at presentation with respect to macular detachment, extent of RD, and presenting visual acuity. At final follow-up, final visual acuity and anatomic outcomes were similar between the 2 groups. These data are helpful for future patient education, triaging, and treatment decision making.


Subject(s)
COVID-19/epidemiology , Retinal Detachment/epidemiology , SARS-CoV-2 , Adult , Aged , Cryotherapy , Female , Humans , Male , Middle Aged , Ontario/epidemiology , Retinal Detachment/physiopathology , Retinal Detachment/surgery , Retrospective Studies , Scleral Buckling/methods , Visual Acuity/physiology , Vitrectomy
12.
Cornea ; 40(1): 123-124, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-998523

ABSTRACT

PURPOSE: To report a case of acute corneal endothelial graft rejection with the concurrent onset of coronavirus disease 2019 (COVID-19) symptoms. METHODS: Case report. RESULTS: A 31-year-old African American woman with a history of asthma, sleep apnea, obesity (body mass index of 40), and bilateral keratoconus was noted to have acute corneal endothelial graft rejection 3 months after uncomplicated penetrating keratoplasty of the left eye. The patient developed dysgeusia and subjective fever on the same day as ocular discomfort, and she was subsequently diagnosed with COVID-19 with only these 2 classic symptoms of the viral infection. CONCLUSIONS: Severe acute respiratory syndrome coronavirus 2 is known to cause conjunctivitis and has demonstrated transmissibility through ocular secretions. Acute immune and inflammatory dysregulations have been seen in cases of COVID-19 through various mechanisms. COVID-19 infection may potentially compromise ocular immune privilege contributing to acute corneal graft rejection.


Subject(s)
COVID-19/diagnosis , Endothelium, Corneal/pathology , Graft Rejection/diagnosis , Keratoconus/surgery , Keratoplasty, Penetrating , SARS-CoV-2 , Acute Disease , Adult , COVID-19/etiology , COVID-19 Testing , Dysgeusia/diagnosis , Female , Graft Rejection/etiology , Humans , Polymerase Chain Reaction , Reoperation , Visual Acuity/physiology
14.
Cornea ; 40(4): 477-483, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-936465

ABSTRACT

PURPOSE: This is a cohort study to evaluate the presence of objective signs and subjective symptoms of dry eye disease in postcoronavirus disease 2019 (COVID-19) patients compared with the control. METHODS: Prospective, observational, single-ctenter, cohort study. Sixty-four post-COVID-19 patients and 50 control were recruited. All participants underwent a complete ophthalmological examination including Ocular Surface Disease Index Questionnaire (OSDI), best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, Schirmer test type 1, tear break-up time test (tBUT), evaluation of conjunctival hyperemia, corneal staining, and tear film osmolarity test. RESULTS: The OSDI score was higher in the post-COVID-19 group in the quantitative and qualitative analysis (P < 0.001 and P =0.012, respectively). The mean tBUT in post-COVID-19 patients was 6.95 ± 4.07 seconds compared with a mean tBUT of 10.12 ± 3.90 seconds in the control group. The post-COVID-19 group showed a higher number of patients with a simultaneous impairment of the OSDI score and tBUT (P = 0.019). The Schirmer test results were strikingly significant both in the quantitative analysis and qualitative analysis (P <0.001 and P = 0.0014, respectively). Both quantitative analysis and qualitative analysis revealed a significant difference in tear osmolarity in the 2 groups. CONCLUSIONS: Comparing the ocular surface assessment of post-COVID-19 patients with heathy control, a statistically significant increase of dry eye disease has emerged both in subjective and objective evaluations. Our clinical results support the findings that suggested a susceptibility of the ocular surface to the virus, and it underlines the importance of the ocular surface assessment in post-COVID-19 patients for a correct diagnosis and therapy.


Subject(s)
COVID-19/complications , Dry Eye Syndromes/etiology , SARS-CoV-2/isolation & purification , Adult , Aged , COVID-19 Serological Testing , Cohort Studies , Diabetes Mellitus/diagnosis , Diabetes Mellitus/etiology , Dry Eye Syndromes/diagnosis , Female , Humans , Male , Middle Aged , Osmolar Concentration , Prospective Studies , Pulmonary Arterial Hypertension/diagnosis , Pulmonary Arterial Hypertension/etiology , Slit Lamp Microscopy , Tears/chemistry , Tears/physiology , Visual Acuity/physiology
15.
J Cataract Refract Surg ; 46(12): e61-e63, 2020 12.
Article in English | MEDLINE | ID: covidwho-910345

ABSTRACT

This case report describes a negative result for antigen testing for the SARS-CoV-2 virus in an aqueous sample taken during the management of suspected herpes simplex keratitis from a patient with confirmed SARS-CoV-2 based on antigen testing of high nasal swab. The implications of no viral load detectable in the aqueous sample are discussed in context of routine phacoemulsification surgery during the SARS-CoV-2 pandemic.


Subject(s)
Aqueous Humor/virology , COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Corneal Stroma/virology , Keratitis, Herpetic/diagnosis , SARS-CoV-2/isolation & purification , Antiviral Agents/therapeutic use , COVID-19/genetics , COVID-19/virology , Ganciclovir/therapeutic use , Humans , Keratitis, Herpetic/drug therapy , Keratitis, Herpetic/virology , Male , Middle Aged , Recurrence , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , Simplexvirus/pathogenicity , Visual Acuity/physiology
17.
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
18.
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
19.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2639-2645, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-680061

ABSTRACT

PURPOSE: To assess the treatment position of all patients who have had an anti-VEGF injection in 2020, prior to the UK lockdown on 23 March. To assess methods of service quality evaluation in setting benchmarks for comparison after the situation stabilized. To consider what proportion could be delayed based on national guidelines and varying vision parameters. Finally, to measure how many patients actually attended. METHOD: A retrospective analysis of data collected from our electronic medical record was performed. Age, sex, reason for injection, visual acuity (VA) for both treated and untreated eyes and number of injections were recorded. The proportion of patients and eyes with ≥ 70 letters were calculated as an assessment of quality of service provision. The proportion of patients that could be delayed was estimated based on published guidelines and varying the parameters of difference between treated and untreated eyes. Finally, the number of patients who actually attended was recorded. RESULTS: About 3364 eyes (2229 neovascular age-related macular degeneration (nAMD), 427 diabetic macular oedema (DMO), 599 retinal vein occlusion (RVO) and 109 other) from 2924 patients were analysed. At the last appointment with injection, 64.4% of patients achieved ≥ 70 letters in their better-seeing eye. Mean VA of the treated eye was 61.5 letters, and 36.9% achieved ≥ 70. The mean number of injections was 16, 90% with aflibercept. Of the patients receiving treatment to one eye, 57.6% was receiving treatment to their worse seeing eye. In 18.2% this eye was > 20 letters worse and in 5.07% > 40 letters worse than the untreated eye. Using Royal College of Ophthalmologists (RCOphth) guidelines, (treat nAMD 8 weekly, delay majority of RVO and DMO) 24.8% would be delayed. From 2738 appointments during the first 4 weeks of lockdown (booked prior to lockdown), doctors rescheduled 1025 and patients did not attend 820, leaving 893 who were seen (33%). CONCLUSIONS: Assessing the treatment position of patients prior to COVID-19 lockdown enables objective stratification for prioritization for continued treatment. If RCOphth guidelines were followed 24.8% could be delayed and if treating the worse seeing eye up to 57.6%. Many scheduled patients elected not to attend, with 67% not seen in the first 4 weeks. The impact of non-attendance and delays may be evaluated later.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Betacoronavirus , Coronavirus Infections/epidemiology , Health Services Accessibility , Macular Edema/drug therapy , Pneumonia, Viral/epidemiology , Retinal Vein Occlusion/drug therapy , Wet Macular Degeneration/drug therapy , Adult , Aged , Aged, 80 and over , COVID-19 , Choroidal Neovascularization/drug therapy , Female , Health Priorities , Health Services Research , Humans , Intravitreal Injections , Male , Middle Aged , Pandemics , Quarantine/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , United Kingdom/epidemiology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Young Adult
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