Is Ocular Toxicity Expected in Chloroquine/Hydroxychloroquine Prescription as a Therapeutic or Prophylactic Option in COVID-19?

BACKGROUND: On 11th March 2020, WHO announced novel coronavirus infectious (COVID-19) as a pandemic. New Coronavirus Pneumonia (NCP) that emerge on 31st December 2019 from China and quickly became a Public Health Emergency of International Concern (PHEIC). In the absence of evidence-based proven prophylactic or therapeutic options, chloroquine/hydroxychloroquine (CQ/HCQ) patented as first line choice in COVID- 19 treatment, which raised concerns about drug poisoning, especially ocular toxicity. OBJECTIVE: This study aims to investigate the possibility of ocular toxicity and the need for ophthalmic counseling to prescribing this therapeutic protocol. METHODS: All the articles that were most relevant to the COVID-19 therapeutic or prophylactic options and CQ derivative ocular toxicity, were founded by a literature search and were thoroughly reviewed. RESULTS: Anecdotal recent reports introduce CQ/HCQ as an effective therapeutic or prophylactic choice for COVID-19. Because of the short time prescribe and the insignificant cumulative dose of the drug on the one hand and a higher risk of cross-infection during an ophthalmic examination, on the other hand, an ophthalmologic consult is not recommended except in highrisk patients for retinal toxicity. CONCLUSION: This study recommended ophthalmic evaluation before CQ/HCQ prescription for treatment or prophylaxis of COVID-19 only in preexisting maculopathy.

A Review on 2019 Novel Coronavirus Pneumonia in Ophthalmology.

PURPOSE: To investigate the possibility of ocular involvement in the 2019-novel coronavirus infectious (2019-nCoV) and vital preventive measures in the field of ophthalmology. METHODS: All the studies that were most relevant to the 2019-nCoV ocular involvement and routes of transmission, especially in the field of ophthalmology, thoroughly reviewed. RESULTS: From the ocular perspective, conjunctivitis may be the first presenting symptom of 2019-nCoV, so, we as ophthalmologists are at the forefront of exposure with newly infected patients. Although transconjunctival aerosol is a suspected but, the main route of transmission is the known respiratory droplets which will be more significant due to close contact in the field of ophthalmology. This review advise a set of recommendation for preventive care to minimize cross-infection of 2019-nCoV. CONCLUSIONS: Ophthalmologists have an essential role in guiding cross-infection control measures between patients and staff. Until a vaccine is created, public health strategies are likely the best weapons against this invisible enemy.

Prevalence of Helicobacter pylori Infection in Patients with Central Serous Chorioretinopathy: A Review.

Helicobacter pylori is a prevalent cause of gastrointestinal infections. Recently, several studies have shown a relationship between H. pylori infection and a variety of extradigestive manifestations. The aim of this study was to review the literature regarding the prevalence of this infection in cases of central serous chorioretinopathy (CSR). We reviewed the EMBASE, Cochrane Library, and Google Scholar search engines; hand-searched many journals; and searched the cited references in published articles for relevant studies. We assessed 81 studies for eligibility. Finally, nine articles that met the inclusion criteria were included. The relationship between H. pylori infection (as the etiologic factor) and chorioretinal involvement was assessed by the effect size with 95% confidence interval (CI). Both fixed- and random-effects models showed that the prevalence of H. pylori infection in patients with CSR was significantly higher than in the control group (2.5-fold and 2.7-fold higher, respectively; P < 0.01). The results were not significantly different between the two models. Treatment of H. pylori infection should be considered in patients with CSR. However, additional randomized controlled clinical trials are required to determine the possible role of H. pylori eradication in the prognosis and treatment of patients with CSR.