ABSTRACT
El objetivo de la presente investigación es identificar y sistematizar las afectaciones generadas por el SARS-CoV-2 en el nervio óptico y en la retina de pacientes jóvenes, adultos y adultos mayores que padecieron COVID-19 en el período del 2019 al 2022. Se realizó una revisión teórica documental (RTD) en el marco de una investigación para determinar el estado actual del conocimiento del tema objeto de estudio. La RTD contempla el análisis de publicaciones en las bases de datos científicas PubMed/Medline, Ebsco, Scielo y Google. Se encontraron un total de 167 artículos de los cuales se estudiaron a profundidad 56 artículos; se evidencia el impacto de la infección por COVID-19 en la retina y el nervio óptico de los pacientes contagiados, tanto durante la fase aguda como en la recuperación posterior. Entre los hallazgos reportados sobresalen: neuropatía óptica isquémica no arterítica anterior y posterior, neuritis óptica, oclusión vascular central o de rama, maculopatía medial aguda paracentral, neurorretinitis, así como también diagnósticos concomitantes como enfermedad posible de Vogt Koyanagi Harada, síndrome de múltiples puntos blancos evanescentes (MEWDS), retinopatía Purtscher-like, y otros (AU)
The objective of this research is to identify and systematize the medical conditions generated by SARS-CoV-2 on the optic nerve and retina of young, adult, and elderly adults who suffered from COVID-19 in the period 2019-2022. A theoretical documentary review (TDR) was conducted within the framework of an investigation to determine the current state of knowledge of the subject under study. The TDR includes the analysis of publications in the scientific databases PubMed/Medline, Ebsco, Scielo and Google. A total of 167 articles were found, of which 56 were studied in depth, and these evidence the impact of COVID-19 infection on the retina and optic nerve of infected patients, both during the acute phase and in subsequent recovery. Among the reported findings, the following stand out: anterior and posterior non-arteritic ischemic optic neuropathy, optic neuritis, central or branch vascular occlusion, paracentral acute medial maculopathy, neuroretinitis, as well as concomitant diagnoses such as possible Vogt-Koyanagi-Harada disease, multiple evanescent white dot syndrome (MEWDS), Purtscher-like retinopathy, among others (AU)
Subject(s)
Humans , Coronavirus Infections/complications , Optic Nerve Diseases/classification , Optic Nerve Diseases/virology , Retinal Diseases/classification , Retinal Diseases/virologyABSTRACT
Cytomegalovirus (CMV) infection is common worldwide, but is usually a subclinical or self-limited infection in immunocompetent patients. On the contrary, most of the ocular and central nervous system involvement occurs in immunosuppressed patient, and usually has severe consequences. Ocular manifestations of CMV infection are frequent in immunosuppressed patients (notably keratouveitis, retinitis and retinal branch angiitis), but a few cases of optic neuropathy (mostly papillitis) have been reported in the literature in immunocompetent patients. We report a case of a young and previously healthy female patient who developed a CMV optic neuropathy after a presumed CMV reinfection. Viral copies were detected in both blood and cerebrospinal fluid, as well as a high IgG titre and no evidence of immunosuppression was found. Clinical improvement was seen after high-dose corticosteroids and ganciclovir.
Subject(s)
Cytomegalovirus Infections/complications , Optic Nerve Diseases/virology , Female , Humans , ImmunocompetenceSubject(s)
COVID-19/complications , Eye Infections, Viral/etiology , Optic Nerve Diseases/etiology , Retinal Diseases/etiology , SARS-CoV-2/immunology , Scotoma/etiology , Tomography, Optical Coherence , Acute Disease , Adult , COVID-19/diagnosis , COVID-19/virology , COVID-19 Serological Testing , Eye Infections, Viral/diagnostic imaging , Eye Infections, Viral/virology , Female , Humans , Male , Optic Nerve Diseases/diagnostic imaging , Optic Nerve Diseases/virology , Pregnancy , Retinal Diseases/diagnostic imaging , Retinal Diseases/virology , Scotoma/diagnostic imaging , Scotoma/virologyABSTRACT
Purpose: To review the broad spectrum of clinical neuro-ophthalmic presentations associated with human immunodeficiency virus (HIV) infection. Methods: Critical review of the literature regarding neuro-ophthalmic consequences of HIV infection and its sequelae. Results: Neuro-ophthalmological diseases are common in both asymptomatic HIV-positive patients and those who profound immunosuppression with acquired immune deficiency syndrome (AIDS). Neuro-ophthalmic manifestations of HIV infection can involve the afferent or efferent visual pathway. Common clinical presentations include headache, papilledema, chorioretinitis, optic nerve involvement, meningitis, and cranial nerve palsies. Other neuro-ophthalmic manifestations include involvement of the visual pathway in the brain producing visual field defects such as occur in progressive multifocal encephalopathy. Pupil abnormalities have also been reported. Discussion: Neuro-ophthalmic consequences of HIV are important to recognize as it is critical to identify underlying neoplastic or infectious diseases which could be amenable to treatment.
Subject(s)
Chorioretinitis/diagnosis , Eye Infections, Viral/diagnosis , HIV Infections/diagnosis , Optic Nerve Diseases/diagnosis , Papilledema/diagnosis , Chorioretinitis/virology , Eye Infections, Viral/virology , HIV Infections/virology , Humans , Optic Nerve Diseases/virology , Papilledema/virology , Vision Disorders/diagnosis , Vision Disorders/virology , Visual FieldsSubject(s)
Cytomegalovirus Retinitis/etiology , Cytomegalovirus , Eye Infections, Viral/etiology , Leukemia, Myeloid, Acute/complications , Optic Nerve Diseases/etiology , Retinal Detachment/etiology , Viremia/complications , Antiviral Agents/administration & dosage , Bone Marrow Transplantation/adverse effects , Child , Cytomegalovirus Retinitis/diagnosis , Cytomegalovirus Retinitis/therapy , Eye Infections, Viral/therapy , Eye Infections, Viral/virology , Fundus Oculi , Ganciclovir/administration & dosage , Humans , Intravitreal Injections , Leukemia, Myeloid, Acute/therapy , Male , Optic Atrophy , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/therapy , Optic Nerve Diseases/virology , Retinal Detachment/diagnosis , Retinal Detachment/therapy , Tomography, Optical Coherence , Viremia/therapy , Viremia/virology , Visual Acuity/physiology , VitrectomyABSTRACT
BACKGROUND: Herpes zoster optic neuropathy (HZON) is a rare manifestation of herpes zoster ophthalmicus (HZO). The aim of our study was to better characterize the clinical features, therapeutic choices, and visual outcomes in HZON. METHODS: A retrospective chart review was performed at multiple academic eye centers with the inclusion criteria of all eyes presenting with optic neuropathy within 1 month of cutaneous zoster of the ipsilateral trigeminal dermatome. Data were collected regarding presenting features, treatment regimen, and visual acuity outcomes. RESULTS: Six patients meeting the HZON inclusion criteria were identified. Mean follow-up was 2.75 months (range 0.5-4 months). Herpes zoster optic neuropathy developed at a mean of 14.1 days after initial rash (range 6-30 days). Optic neuropathy was anterior in 2 eyes and retrobulbar in 4 eyes. Other manifestations of HZO included keratoconjunctivitis (3 eyes) and iritis (4 eyes). All patients were treated with systemic antiviral therapy in addition to topical and/or systemic corticosteroids. At the last follow-up, visual acuity in 3 eyes had improved relative to presentation, 2 eyes had worsened, and 1 eye remained the same. The 2 eyes that did not receive systemic corticosteroids had the best observed final visual acuity. CONCLUSION: Herpes zoster optic neuropathy is an unusual but distinctive complication of HZO. Visual recovery after HZON is variable. Identification of an optimal treatment regiment for HZON could not be identified from our patient cohort. Systemic antiviral agents are a component of HZON treatment regimens. Efficacy of systemic corticosteroids for HZON remains unclear and should be considered on a case-by-case basis.
Subject(s)
Herpes Zoster Ophthalmicus/diagnosis , Herpesvirus 3, Human/isolation & purification , Optic Nerve Diseases/diagnosis , Adult , Aged , Antiviral Agents/therapeutic use , Drug Therapy, Combination , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/physiopathology , Herpes Zoster Ophthalmicus/virology , Humans , Male , Middle Aged , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/physiopathology , Optic Nerve Diseases/virology , Retrospective Studies , Visual Acuity/physiologySubject(s)
Cranial Nerve Diseases/diagnosis , Eye Infections, Viral/diagnosis , Herpes Zoster Ophthalmicus/diagnosis , Ocular Motility Disorders/diagnosis , Orbital Diseases/diagnosis , Abducens Nerve Diseases/diagnosis , Abducens Nerve Diseases/drug therapy , Abducens Nerve Diseases/virology , Acyclovir/therapeutic use , Aged , Antiviral Agents/therapeutic use , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/virology , Epithelium, Corneal/pathology , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Glucocorticoids/therapeutic use , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/virology , Humans , Male , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/virology , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/drug therapy , Oculomotor Nerve Diseases/virology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/virology , Orbital Diseases/drug therapy , Orbital Diseases/virology , Prednisolone/therapeutic use , Trigeminal Nerve Diseases/diagnosis , Trigeminal Nerve Diseases/drug therapy , Trigeminal Nerve Diseases/virology , Trochlear Nerve Diseases/diagnosis , Trochlear Nerve Diseases/drug therapy , Trochlear Nerve Diseases/virologyABSTRACT
PURPOSE: To determine whether there is an optic neuropathy (ON) in patients with human T-cell lymphotropic virus type 1 (HTLV-1) infection. METHODS: We included HTLV-1 asymptomatic carriers (a.c.HTLV-1) and tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM) patients between January 1st, 2014 and March 31st, 2015. All patients had complete eye examination. The visual acuity (VA) and retinal nerve fiber layer (RNFL) thickness were measured and compared to age- and sex-matched control groups including patients seen in our refraction clinic with no previous medical or surgical history. RESULTS: Thirty-one a.c.HTLV-1 (group 1) and 29 TSP/HAM patients (group 2) were included. The average RNFL thickness was 99.9 ± 14.3 µm in group 1 and 87.8 ± 19.2 µm in group 2. The average RFNL thicknesses were lower in both groups, when compared to controls. The difference was significant in patients with TSP/HAM (87.8 ± 19.2 µm vs. 97 ± 7.8 µm; p = 0.003) who also had significantly decreased VA. CONCLUSIONS: We report here the first study about the RNFL thickness in patients with TSP/HAM. In these patients, there is decrease of the RNFL thickness with subtle but definite decrease of VA. This suggests that subclinical ON occurs in the natural history of the disease. The diagnosis of TSP/HAM must be evoked as a differential of primary progressive multiple sclerosis in a population at risk. Moreover, RNFL thinning with no evidence of glaucoma should raise suspicion for HTLV-1 infection and TSP/HAM in a population at risk.
Subject(s)
Eye Infections, Viral/diagnosis , Human T-lymphotropic virus 1/isolation & purification , Nerve Fibers/pathology , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Paraparesis, Tropical Spastic/diagnosis , Retinal Ganglion Cells/pathology , Aged , Blotting, Western , Eye Infections, Viral/virology , Female , Humans , Immunoenzyme Techniques , Male , Middle Aged , Optic Nerve Diseases/virology , Paraparesis, Tropical Spastic/virology , Prospective Studies , Tomography, Optical Coherence , Visual Acuity/physiologyABSTRACT
PURPOSE OF REVIEW: The aim of this study was to review the ocular findings related to the Zika virus (ZIKV) based on the main studies published to date, describe the patterns of the lesions and risk factors, and identify the public health implications and scientific importance of this emerging disease. RECENT FINDINGS: In most studies, the ZIKV seems related to congenital ocular lesions and most mothers reported mild symptoms during the first pregnancy trimester. Five fundus patterns were seen most often: macular chorioretinal atrophy, chorioretinal atrophy elsewhere, focal pigmentary changes in the macular region, optic nerve abnormalities and combined types. A few studies have suggested that the ZIKV might damage the anterior segment of these babies' eyes. Few reports have described the ocular complications seen in adults during the acute infection, including conjunctivitis, iridocyclitis and chorioretinitis. SUMMARY: Infants with congenital Zika syndrome might have vision-threatening fundus abnormalities. Although the full spectrum of ocular lesions caused by the ZIKV infection is not yet determined, a distinctive new disease has been observed. Recognition of these lesions by ophthalmologists can help ensure appropriate etiologic evaluation and clinical investigation to define the range of anomalies in an affected infant and determine essential follow-up and ongoing care.
Subject(s)
Communicable Diseases, Emerging , Eye Infections, Viral/diagnosis , Pregnancy Complications, Infectious/diagnosis , Zika Virus Infection/diagnosis , Zika Virus , Chorioretinitis/diagnosis , Chorioretinitis/virology , Eye Infections, Viral/virology , Female , Humans , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/virology , Pregnancy , Pregnancy Complications, Infectious/virology , Zika Virus Infection/virologyABSTRACT
Parvovirus B19 (PB19) is a common, widespread, small, single-stranded DNA virus which has been linked with a broad spectrum of clinical illnesses, including a variety of neurological complications such as encephalitis, meningitis, myelitis, stroke, cerebellar ataxia, and neuropathy. The authors describe a case of PB19 infection associated with hemolytic anemia and cranial polyneuropathy involving the second and third cranial nerves in a 23-year-old immunocompetent woman. The diagnosis of acute PB19 infection was established with detection of positive DNA and anti-PB19 IgM antibodies in blood samples. Antiganglioside antibody studies were performed and serum anti-GD1b IgG was strongly positive. Further investigation was normal or negative, excluding other infectious or autoimmune disorders. The patient was initially treated with a 5-day course of intravenous immunoglobulin (IGIV). Because of incomplete neurological recovery, methylprednisolone was also administered 7 days after IGIV therapy initiation. Complete resolution of clinical symptoms was observed 3 months after disease onset at follow-up visit, despite the persistence of PB19 DNA and anti-PB19 IgM antibodies in serum 5 months after the initial presentation. Our report provides evidence that PB19 could affect both the central and peripheral nervous system, possibly by triggering an autoimmune mechanism that leads to autoantibody production.
Subject(s)
Anemia, Hemolytic/virology , Erythema Infectiosum/complications , Oculomotor Nerve Diseases/virology , Optic Nerve Diseases/virology , Autoantibodies/immunology , Autoantigens/immunology , Erythema Infectiosum/immunology , Female , Gangliosides/immunology , Humans , Polyneuropathies/virology , Young AdultSubject(s)
Communicable Diseases, Emerging , Eye Infections, Viral/epidemiology , Optic Nerve Diseases/epidemiology , Pregnancy Complications, Infectious/virology , Zika Virus Infection/virology , Eye Infections, Viral/virology , Female , Humans , Infant , Infant, Newborn , Microcephaly/epidemiology , Optic Nerve Diseases/virology , Pregnancy , Zika VirusSubject(s)
HIV Infections/complications , Optic Nerve Diseases/virology , Eye/pathology , Humans , Male , Middle Aged , Visual Field TestsABSTRACT
PURPOSE: Some human immunodeficiency virus (HIV)-infected individuals have evidence of optic nerve or retinal dysfunction that manifests as decreased contrast sensitivity, even with good best-corrected visual acuity (BCVA). This condition, termed HIV-related neuroretinal disorder (HIV-NRD), is a risk factor for vision impairment (BCVA <20/40), blindness (BCVA ≤20/200), and increased mortality. We investigated the effect of HIV-NRD on vision-specific quality of life (QOL). DESIGN: Cross-sectional analysis of data from a prospective, observational study. PARTICIPANTS: Individuals from the Longitudinal Study of the Ocular Complications of AIDS cohort who completed the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25), had BCVA of 20/40 or better, and had no evidence of ocular opportunistic infection or cataract. METHODS: We compared QOL by HIV-NRD status, adjusting for potential confounding variables, using multiple linear regression. Among those with HIV-NRD, we assessed the relationship between VFQ-25 and the logarithm of contrast sensitivity (logCS), using Spearman correlation. We defined a minimum clinically important difference (MCID) as 1 standard error of measurement from a well-characterized, historical population of individuals with a variety of ophthalmic disorders. MAIN OUTCOME MEASURES: Subscales and composite VFQ-25 scores (0 = worst, 100 = best). RESULTS: A total of 813 individuals met study criteria. Those with HIV-NRD (n = 39 [4.8%]) had a lower mean composite score than those without HIV-NRD (81 vs. 89; P = 0.0002) and lower mean scores in the following subscales: near activities (77 vs. 86; P = 0.004), distance activities (85 vs. 91; P = 0.01), social functioning (89 vs. 96; P = 0.0005), mental health (75 vs. 87; P = 0.0001), dependency (81 vs. 94; P < 0.0001), driving (75 vs. 85; P = 0.02), color vision (90 vs. 97; P < 0.0001), and peripheral vision (85 vs. 91; P = 0.0496). Score differences for each of these subscales met criteria for MCID. Among those with HIV-NRD, there was a positive correlation between logCS and composite score (r = 0.36; 95% confidence interval, 0.04-0.60). CONCLUSIONS: HIV-NRD has a statistically significant and clinically meaningful association with decreased vision-specific QOL among people with AIDS and good BCVA.
Subject(s)
Acquired Immunodeficiency Syndrome/psychology , Eye Infections, Viral/psychology , Optic Nerve Diseases/psychology , Quality of Life/psychology , Retinal Diseases/psychology , Vision Disorders/psychology , Acquired Immunodeficiency Syndrome/virology , Adult , Contrast Sensitivity/physiology , Cross-Sectional Studies , Eye Infections, Viral/virology , Female , HIV-1/pathogenicity , Humans , Male , Middle Aged , Optic Nerve Diseases/virology , Prospective Studies , Retinal Diseases/virology , Sickness Impact Profile , Surveys and Questionnaires , Visual Acuity/physiologyABSTRACT
Viral infection is a rare cause of painful ophthalmoplegia. We report on a 67-year-old patient who developed painful double vision after a vesicular skin rash on the left forehead. MRI disclosed simultaneous inflammatory lesions in all extraocular muscles, the second and third cranial nerve, as well as pathological signal intensity along the spinal trigeminal tract and nucleus within the medulla oblongata and the pons. Cerebrospinal fluid and serum tests for varicella zoster were positive. The patient was treated effectively with intravenous acyclovir and methylprednisolone. Simultaneous lesions in various neighbouring neural structures may be characteristic for the highly neurotropic behaviour of the herpesviridae and should be considered as a cause of painful ophthalmoplegia that can be depicted by appropriate imaging.
Subject(s)
Herpes Zoster Ophthalmicus/complications , Herpesvirus 3, Human , Oculomotor Nerve Diseases/etiology , Optic Nerve Diseases/etiology , Orbital Myositis/etiology , Tolosa-Hunt Syndrome/etiology , Trigeminal Nuclei/virology , Acyclovir/therapeutic use , Aged , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Diplopia/diagnosis , Exanthema/diagnosis , Female , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/pathology , Herpes Zoster Ophthalmicus/virology , Humans , Methylprednisolone/therapeutic use , Oculomotor Nerve/pathology , Oculomotor Nerve/virology , Oculomotor Nerve Diseases/drug therapy , Oculomotor Nerve Diseases/virology , Optic Nerve/pathology , Optic Nerve/virology , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/virology , Orbit/pathology , Orbit/virology , Orbital Myositis/drug therapy , Orbital Myositis/virology , Tolosa-Hunt Syndrome/drug therapy , Tolosa-Hunt Syndrome/pathology , Tolosa-Hunt Syndrome/virology , Trigeminal Nuclei/pathologyABSTRACT
Optic nerve involvement may occur in various infectious diseases, but is rarely reported after infection by the human immunodeficiency virus (HIV). We report the atypical case of a 38-year-old patient in whom the presenting features of HIV infection were due to a bilateral optic neuropathy associated with macular subretinal fluid and cystoid macular edema, which responded well to antiretroviral therapy.
Subject(s)
HIV Infections/complications , Macular Edema/virology , Optic Nerve Diseases/virology , Vision Disorders/virology , Adult , HIV Infections/pathology , Humans , Macula Lutea/pathology , Macular Edema/pathology , Male , Optic Nerve/pathology , Optic Nerve Diseases/pathology , Vision Disorders/pathologyABSTRACT
HIV-related optic neuropathy is rare compared to optic neuropathies secondary to opportunistic infections in seropositive patients. We report the case of a 39-year-old HIV-positive woman referred for unilateral visual loss leading to the diagnosis of recurrent, unilateral, inflammatory optic neuropathy directly associated with HIV. Despite initial recovery after steroid treatment, she relapsed twice. Absence of any opportunist infections or toxic causes and presence of a very high viral load due to non-compliance with treatment led to the diagnosis of HIV-related optic neuropathy. Steroids and effective anti-retroviral treatment resulted in definitive and complete recovery. Inflammatory, degenerative and/or vascular mechanisms have been hypothesized to explain the occurrence of these rare HIV-related optic neuropathies. This diagnosis remains a diagnosis of exclusion to be considered in the work-up of seropositive patients with optic neuropathies.
Subject(s)
HIV Infections/complications , HIV-1/physiology , Optic Nerve Diseases/etiology , Adult , Cote d'Ivoire , Female , HIV Infections/physiopathology , Humans , Optic Nerve Diseases/pathology , Optic Nerve Diseases/physiopathology , Optic Nerve Diseases/virology , Recurrence , Visual Acuity/physiologyABSTRACT
We describe three patients with bilateral, presumed human immunodeficiency virus (HIV)-induced optic neuropathy. The above diagnosis was made by exclusion of infectious agents and neoplasms by detailed clinical and laboratory investigations. All patients had decreased visual acuity, pale optic discs and constriction of visual fields. Improvement was documented in all three patients for visual acuity and in one patient for visual fields following treatment with highly active antiretroviral therapy (HAART). Optic neuropathy in HIV-positive patients does not necessarily carry a poor prognosis even when a treatable cause is not found. This article emphasizes the effectiveness of HAART in presumed HIV-induced optic neuropathy.
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Optic Nerve Diseases/complications , Optic Nerve Diseases/virology , Vision Disorders/etiology , Vision Disorders/physiopathology , Adolescent , Adult , Female , Humans , Male , Recovery of FunctionABSTRACT
Leukemic infiltration is a common cause of optic disk swelling in a patient with acute lymphoblastic leukemia (ALL). Recurrence of optic disk swelling in a patient with previous leukemic infiltration carries a grave prognosis when it is associated with recurrent central nervous system disease. We report a case of recurrent swelling of an optic disk in a patient with T-cell ALL who had previously been treated for CNS relapse with optic nerve involvement. In this case the swelling was associated with cytomegalovirus infection and resolved following treatment with antiviral therapy.
Subject(s)
Herpesviridae Infections/pathology , Leukemic Infiltration/pathology , Optic Nerve Diseases/virology , Optic Nerve/virology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Adolescent , Functional Laterality , Humans , Male , Visual AcuityABSTRACT
A 39-year-old man presented with headache, weight loss, bilateral subdural hematomas, pansinusitis, and visual loss. The neuro-ophthalmologic examination disclosed deep choroidal lesions and bilateral optic disc edema. Orchiectomy for testicular torsion showed acute vasculitis consistent with polyarteritis nodosa (PAN). Polymerase chain reaction (PCR) testing revealed hepatitis C. This is the first reported case of PAN due to hepatitis C with early findings of choroidal and optic nerve infarction.