Long-term ocular damage after recovery from COVID-19: lack of evidence at three months

Importance A small number of COVID-19 patients has been reported to suffer from acute keratoconjunctivitis. In very rare cases, acute inflammatory retinal vein occlusion, papillophlebitis or retinopathy have been observed. Objective To determine possible long-term effects on the eye, especially on the retina, in patients who had suffered from COVID-19 at least 3 months after recovery. Design Prospective cross-sectional study. Setting Hospital of the Ludwig Maximilians University, Munich. Participants Patients who had been tested positive for SARS-CoV-2 or for anti-SARS-CoV-2 IgG serum antibodies in the Hospital of the Ludwig Maximilians University, Munich between May and September. Methods Patients who had tested positive were either hospitalized or discharged into home quarantine via the emergency room. Three months after recovery, they were invited to participate voluntarily for this study during their follow-up in our clinic. A complete ophthalmological exam including functional and imaging end points (including optical coherence tomography (OCT), OCT angiography) was performed. Main outcomes and measures Visual acuity, slit lamp, bio microscopy and fundoscopy, multimodal imaging findings. Results In total, 21 patients were examined. The mean age (SD) of the patients was 48.7 (18.3) years. Of these, 14 (66.6%) were hospitalized and 7 (33.3) were discharged home. Two hospitalized patients (9.5%) received invasive ventilation. During the infection, 14 of the 21 patients (66.6%) were in regular care whereas 2 patients (9.5%) received intensive care ventilation for 8.5 (SD) (0.7) days on average in the COVID ICU. Ophthalmological examination of the previously hospitalized group took place 111.4 (23.2) days after recovery and discharge from the hospital, while non-hospitalized patients were examined after mean 123.4 (44.7) days. All patients showed normal findings for anterior and posterior segment of both eyes. OCT and OCT-A showed no evidence of retinal damage, or vascular or microvascular events. Conclusion and relevance This study with a small prospective cohort of 21 patients indicates that there might be no evidence of ocular complications at 3 months after recovery from COVID-19, without previous eye involvement. Further studies with more participants with and without acute ocular symptoms are necessary for final evidence.

Mask wearing increases eye involvement during smiling: a facial EMG study

The use of face masks has become ubiquitous. Although mask wearing is a convenient way to reduce the spread of disease, it is important to know how the mask affects our communication via facial expression. For example, when we are wearing the mask and meet a friend, are our facial expressions different compared to when we are not? We investigated the effect of face mask wearing on facial expression, including the area around the eyes. We measured surface electromyography from zygomaticus major, orbicularis oculi, and depressor anguli oris muscles, when people smiled and talked with or without a mask. Only the actions of the orbicularis oculi were facilitated by wearing the mask. We thus concluded that mask wearing may increase the recruitment of the eyes during smiling. In other words, we can express joy and happiness even when wearing a face mask.

Clinical patterns of Uveitis in a Regional Eye Institute of North India

Background: Uveitis encompasses many conditions, all characterized by inflammation of the uvealtract either directly or indirectly. It can occur at any age but predominantly affects patients in theworking-age group. Objective: To report the clinical pattern of Uveitis in North India. Settings andDesign: A prospective study in a regional eye institute. Methods: After taking informed consent,100 patients with Uveitis aged 20–60 years were recruited from eye OPD between 2012- 2014.Detailed history, complete ophthalmic examination, standard diagnostic laboratory tests andradiographic studies wherever required were made. Statistical analysis used: Descriptive.Results: The mean age being 41.55 years. There were 57% males and 43% females with 32%acute uveitis and 68% chronic uveitis cases. Anterior Uveitis was seen in 83% of patients, followedby posterior Uveitis (7%), pan-uveitis (6%) and intermediate Uveitis (4%). A definite associationwith the systemic disease was determined in 27% of cases. The most frequently observed systemicdiseases were ankylosing spondylitis, Tuberculosis and herpes zoster ophthalmicus (6% cases each).This was followed by HIV (3%), sarcoidosis (3%), ulcerative colitis (2%) and endophthalmitis (1%).No specific aetiology or association with systemic diseases could be established in 73% of cases. Inmost cases, the systemic disease was not suspected before eye involvement and was recognizedonly after the subsequent diagnostic procedures. Conclusion: The etiological diagnosis of Uveitis isoften challenging as there are marked variations in ocular and systemic signs and symptoms. Asignificant number of cases may unfold with the evolution of advanced techniques.

Profile of Mucormycosis Cases from a Network of Hospitals in North India Amidst COVID-19 Pandemic

Incidence of mucormycosis suddenly surged in India after the second wave of COVID-19. This is a crippling disease and needs to be studied in detail to understand the disease, its course, and the outcomes. Between 1st March and 15th July 2021, our network of hospitals in North India received a total of 155 cases of COVID-associated mucormycosis cases as all of them reported affliction by COVID-19 earlier or concurrent. Their records were retrieved from the Electronic Health Records system of the hospitals and their demographics, clinical features, treatments, and outcomes were studied. More than 80% (125 cases) had proven disease and the remaining 30 were categorized as possible mucormycosis as per the EORTC criteria. More than two-thirds (69.0%) of the cases were males and the mean age was 53 years for either sex. Nearly two-thirds (64.5%) had symptoms of nose and jaws and 42.6% had eye involvement. Some had multiple symptoms. As many as 78.7% had diabetes and 91.6% gave history of use of steroids during COVID-19 treatment. The primary surgery was functional endoscopic sinus surgery (FESS) (83.9%). Overall mortality was 16.8%, which is one-and-a-half times the mortality in hospitalized COVID-19 patients in the corresponding population. Occurrence of mucormycosis was associated with diabetes and use of steroids, but mortality was not associated with either of them. Cases undergoing surgery and on antifungal had steeply lower mortality (11.9% vs. 50.0%, P < 0.001) than those who were exclusively on antifungal drugs. Treatment by different drugs did not make much of a difference in mortality.

Ocular Involvement in Hereditary Amyloidosis

The term amyloidosis describes a group of rare diseases caused by protein conformation abnormalities resulting in extracellular deposition and accumulation of insoluble fibrillar aggregates. So far, 36 amyloid precursor proteins have been identified, and each one is responsible for a specific disease entity. Transthyretin amyloidosis (ATTRv) is one of the most common forms of systemic and ocular amyloidosis, due to the deposition of transthyretin (TTR), which is a transport protein mainly synthesized in the liver but also in the retinal pigment epithelial cells. ATTRv amyloidosis may be misdiagnosed with several other conditions, resulting in a significant diagnostic delay. Gelsolin and keratoepithelin are other proteins that, when mutated, are responsible for a systemic amyloid disease with significant ocular manifestations that not infrequently appear before systemic involvement. The main signs of ocular amyloid deposition are in the cornea, irido-corneal angle and vitreous, causing complications related to vasculopathy and neuropathy at the local level. This review aims at describing the main biochemical, histopathological and clinical features of systemic amyloidosis associated with eye involvement, with particular emphasis on the inherited forms. We discuss currently available treatments, focusing on ocular involvement and specific ophthalmologic management and highlighting the importance of a prompt treatment for the potential sight-threatening complications derived from amyloid deposition in ocular tissues.

Retrospective Analysis of Firecracker Injuries and Review of Literature at a Tertiary Eye Care Hospital in South India

Purpose: To analyze demographics, risk factors, clinical features, functional, anatomical outcomes, and prevalence of blindness in firecracker injury patients presenting to a major tertiary eye care centre.Methodology: A retrospective analysis of firecracker injury patients who presented to our tertiary eye care hospital was performed from April 2018 to March 2019. A total of 114 patients with a minimum follow-up of 3 months were included. The parameters recorded were demographics, mode of injury, type of cracker, baseline best-corrected visual acuity (BCVA) and on last follow up, detailed anterior and posterior segment evaluation, seidel's test, intraocular pressure, gonioscopy, complications, treatment, functional and anatomical outcomes. Investigations in the form of B Scan, X-ray, or CT scan were undertaken whenever indicated. Results: A total of 132 eyes of 114 patients were analysed. The mean (SD) age of patients was 18.96 +/- 15.4 years (range 3-71 years). Seventy-four (64.91%) patients were less than or equal to 18 years of age. The male-to-female ratio was 4:1. The ratio of right: left eye involvement was 1:1. Eighteen patients (15.79%) had bilateral involvement. A total of 125 eyes had closed globe injury, 7 eyes had open globe injury and 17 patients needed hospital admission for management. The mean (SD) baseline BCVA was 0.54(+/- 0.75). The mean (SD) final BCVA improved to 0.23(+/- 0.62) till the last follow-up. The final outcome was good in most patients, except 5 eyes (3.78%) which resulted in near/total blindness. Conclusion: Firecracker injuries are a major cause of irreversible blindness, and these are more common in the younger age group (64.91%). Prompt diagnosis with meticulous management can prevent devastating sequelae.

An Integrated Approach to the Role of Neurosonology in the Diagnosis of Giant Cell Arteritis

Giant cell arteritis (GCA) is a primary vasculitis that affects especially extracranial medium-sized arteries, such as superficial temporal arteries (TAs). Three findings are important for the ultrasound (US) diagnosis of TA: „dark halo” sign, which represents vessel wall edema, stenosis, and acute occlusions. US has a high sensitivity to detect vessel wall thickening in the case of large vessels GCA. The eye involvement in GCA is frequent and consists in arteritic anterior ischemic optic neuropathies or central retinal arterial occlusion, with abrupt, painless, and severe loss of vision of the involved eye. Because findings of TAs US do not correlate with eye complications in GCA, color Doppler imaging of the orbital vessels is of critical importance (it reveals low end diastolic velocities, and high resistance index), in order to quickly differentiate the mechanism of eye involvement (arteritic, versus non-arteritic). The former should be treated promptly with systemic corticosteroids to prevent further visual loss of the fellow eye.

CONGENITAL PTOSIS IN KASHMIRI POPULATION: A DEMOGRAPHIC STUDY

Purpose: To report the demographic details of congenital ptosis. Design:Retrospective study. Material And Method: A retrospective single institutional study was conducted on 37 eyes of 35 patients having congenital Ptosis whose data was obtained from the hospital records. Results: The mean age of presentation of congenital ptosis patients was 17.3±6.58 years, out of which 48.6% were males and 51.4 % were females. The right eye involvement was 54.3% while that of the left eye was 31.4%. 14.3% were bilateral cases. Conclusion: The study conducted on 37 eyes of 35 patients revealed that the age of presentation for congenital ptosis in a majority of patients (48.6%) was 21-30years. There was equal gender predilection and right eye involvement was more common.