Endogenous Fungal Endophthalmitis following COVID-19 Hospitalization: Evidence from a Year-Long Observational Study.

PURPOSE: To describe cases of endogenous fungal endophthalmitis (EFE) post-recovery from or hospitalization for coronavirus disease 2019 (COVID-19). METHODS: This prospective audit involved patients with suspected endophthalmitis referred to a tertiary eye care center over a one-year period. Comprehensive ocular examinations, laboratory studies, and imaging were performed. Confirmed cases of EFE with a recent history of COVID-19 hospitalization±intensive care unit admission were identified, documented, managed, followed up, and described. RESULTS: Seven eyes of six patients were reported; 5/6 were male, and the mean age was 55. The mean duration of hospitalization for COVID-19 was approximately 28 days (14-45); the mean time from discharge to onset of visual symptoms was 22 days (0-35). All patients had underlying conditions (5/6 hypertension; 3/6 diabetes mellitus; 2/6 asthma) and had received dexamethasone and remdesivir during their COVID-related hospitalization. All presented with decreased vision, and 4/6 complained of floaters. Baseline visual acuity ranged from light perception (LP) to counting fingers (CF). The fundus was not visible in 3 out of 7 eyes; the other 4 had "creamy-white fluffy lesions" at the posterior pole as well as significant vitritis. Vitreous taps were positive for Candida species in six and Aspergillus species in one eye. Anti-fungal treatment included intravenous amphotericin B followed by oral voriconazole and intravitreal amphotericin B. Three eyes underwent vitrectomy; the systemic health of two patients precluded surgery. One patient (with aspergillosis) died; the others were followed for 7-10 months - the final visual outcome improved from CF to 20/200-20/50 in 4 eyes and worsened (hand motion to LP) or did not change (LP), in two others. CONCLUSION: Ophthalmologists should maintain a high index of clinical suspicion for EFE in cases with visual symptoms and a history of recent COVID-19 hospitalization and/or systemic corticosteroid use - even without other well-known risk factors.

Acute macular neuroretinopathy and COVID-19 vaccination: Case report and literature review.

OBJECTIVE: To review cases of acute macular neuroretinopathy (AMN) after COVID-19 vaccination and add a similar case to the literature. METHODS: A thorough PubMed search was conducted, and data from studies describing AMN after COVID-19 vaccination were extracted, tabulated, pooled, and reviewed. RESULTS: We present a case of AMN in a young woman 5 days after immunization with the BBIBP-CorV (Sinopharm) COVID-19 vaccine. Data from 21 cases were pooled and reviewed. The most frequent vaccines among the cases were recombinant ones (13/21), followed by mRNA-based (6/21) and inactivated vaccines (2/21). Only one patient (5%) was male. Seventeen over twenty-one (81%) were young women, ages 18-33. Most cases (14/21; 67%) reported recent/concurrent use of contraceptive medication. In 90% of cases (19/21), symptoms appeared within 8 days of vaccination. A confined wedge-/oval-shaped lesion morphology was more frequent than a diffuse, semilunar one. Resolution of symptoms took 4 to over 15 weeks. CONCLUSION: Attention should be paid to the history of vaccination and contraceptive use in patients with sudden-onset visual symptoms. Optical coherence tomography is integral to the detection of AMN-related abnormalities.