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Bansal R, Bora I, Kanta P, Singh MP, Angrup A, Suri V, Mohindra R, Jaswal S, Meena SC, Bhalla A, Malhotra P, Gupta V, Ray P. Cycle threshold values of SARS-CoV-2 RNA in conjunctival swabs and nasopharyngeal secretions: a comparative study from a tertiary care center in India. Int Ophthalmol 2024; 44:29. [PMID: 38329577 DOI: 10.1007/s10792-024-02976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/29/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE To detect the viral RNA load of SARS-CoV-2 in conjunctival swabs of COVID-19 patients, and compare with nasopharyngeal swabs. METHODS Conjunctival swabs of COVID-19 patients (with PCR positive nasopharyngeal swabs) were subjected to quantitative reverse transcription-polymerase chain reaction (RT-PCR) for detection of SARS-CoV-2 RNA. The cycle threshold (Ct) values of Open Reading Frame 1 (ORF 1 Ab gene) and nucleoprotein (N gene) PCRs were used to assess the viral RNA load, and compare them with the baseline values of nasopharyngeal swabs. RESULTS Of 93 patients, 17 (18.27%) demonstrated SARS-CoV-2 RNA in conjunctival swabs. Baseline nasopharyngeal swabs were collected at a median of 2 days; while, the conjunctival swabs were collected at median 7 days, from onset of illness (p < 0.001). Despite a significant delay in conjunctival swab collection than nasopharyngeal swabs, the Ct values (ORF or N gene PCRs) were comparable between nasopharyngeal swab and conjunctival swab samples. Subsequently, during the recovery period, in four of these 17 patients (with conjunctival swab positivity), when the second nasopharyngeal swab was 'negative', the conjunctival swab was 'positive'. CONCLUSION The conjunctival swabs demonstrated SARS-CoV-2 RNA in 17 (18.27%) of 93 COVID-19 patients. Our results may suggest a delayed or a prolonged shedding of the virus/viral RNA on the ocular surface than in nasopharyngeal mucosa.
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Ishani Bora
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Poonam Kanta
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jaswal
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Charan Meena
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pallab Ray
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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3
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Vohra SB, Kumar CM. International survey of ophthalmic anaesthesia service provision, protection of anaesthesia providers and patients during COVID-19 pandemic: a wake-up call. Eye (Lond) 2023; 37:548-553. [PMID: 35220400 PMCID: PMC8881697 DOI: 10.1038/s41433-022-01979-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS This international survey was conducted to study the impact of Covid-19 pandemic on the provision and practices of ophthalmic anaesthesia, evaluate the methods employed by parent ophthalmic units for safeguarding their anaesthesia providers and patients during lockdown, and to assess pandemic's effect on anaesthesia providers as individuals. The study was done with the hope that the results will help in protecting patients and safeguarding precious human resource by better management if this pandemic was to continue or there was to be another pandemic. METHODS An anonymous questionnaire survey was distributed electronically between December 2020-January 2021 to the practicing ophthalmic anaesthesia providers in different parts of the world. RESULTS The survey identified that apart from reducing elective operating services, the ophthalmic units were ill prepared for the pandemic and the overall management was lacklustre. There was a definite lack of effective peri-operative patient screening, and, streaming processes. Measures for personal protection of staff were not optimal especially during regional/local ophthalmic anaesthesia. Severity of the pandemic, sudden job plan changes, and redeployment to intensive care units/acute covid wards had an adverse psychological impact on the affected staff. CONCLUSION Ophthalmic anaesthesia services worldwide have had poor attentiveness to the life-threatening menace and reality of Covid-19 pandemic. A review of the institutional practices to address correctible deficiencies is urgently required. Robust, mandatory, elective, timely preventative strategies need to be implemented to protect patients, and, the precious ophthalmic workforce from potential adverse physical and psychological injuries.
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Affiliation(s)
- Shashi B. Vohra
- Department of Anaesthesia, Critical Care and Pain Management, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QH UK
| | - Chandra M. Kumar
- Newcastle University, Gelang Patah, Johor Malaysia ,grid.415203.10000 0004 0451 6370Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore, 768828 Singapore
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4
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Loskutov IA, Korsakova NV, Lyakhova EA, Poromov AA, Pshenichnaya NY, Maleev VV. [Ophthalmic manifestations of COVID-19]. Vestn Oftalmol 2023; 139:81-88. [PMID: 37942601 DOI: 10.17116/oftalma202313905181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
In March 2020 the World Health Organization (WHO) declared a pandemic of the novel coronavirus infection (COVID-19) caused by the SARS-CoV-2 respiratory virus. The high spread rate of the virus and the severity of the course of the disease are of great clinical and epidemiological significance, making it relevant for ophthalmologists to study the mechanisms of how SARS-CoV-2 infects ocular structures, as well as possible clinical manifestations of the infection in the organ of vision. This review contains analysis, systematization, and generalization of epidemiological and clinical data on SARS-CoV-2 ocular lesions and was carried out with the data found in scientific abstract databases. The article presents main clinical ophthalmic manifestations of COVID-19, lists the utilized schemes of etiotropic and symptomatic therapy, recommended preventive measures, and considers the possible ophthalmic complications after vaccination against COVID-19.
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Affiliation(s)
- I A Loskutov
- Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - N V Korsakova
- Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
- Cheboksary branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Cheboksary, Russia
| | | | - A A Poromov
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - N Yu Pshenichnaya
- Central Research Institute of Epidemiology, Moscow, Russia
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - V V Maleev
- Central Research Institute of Epidemiology, Moscow, Russia
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5
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Furdova A, Vesely P, Trnka M, Novakova E, Stubna M, Furda R, Branikova L, Pridavkova Z. Conjunctival Swab Findings in 484 COVID-19 Patients in Four Hospital Centers in Slovakia. Vision (Basel) 2022; 6:vision6030046. [PMID: 35893763 PMCID: PMC9330891 DOI: 10.3390/vision6030046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
Since 2020, the COVID-19 (Coronavirus Disease 2019) has quickly become a worldwide health problem. Ophthalmologists must deal with symptoms as well. For the positive detection in the conjunctival sac swab in COVID-19 patients hospitalized in Slovakia during March 2021 in four hospital centers, we used a test based on a polymerase chain reaction (PCR). In a group of 484 patients, 264 males (55%) and 220 females (45%) with clinical symptoms were identified with COVID-19 as a clinical diagnosis. The PCR test swab results from the conjunctival sac taken on the same day were positive in 58 patients (12%), 31 males (with a mean age of 74.6 ± 13.59 years) and 27 females (with a mean age of 70.63 ± 14.17 years); negative in 417 patients (86%); and 9 patients (2%) had an unclear result. The cycle threshold values comparing the nasopharynx and conjunctiva were also different in the group of all patients divided by age and gender. In COVID-19 patients the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was detectable using PCR test in the nasopharynx but also in the conjunctival sac swab, where the positivity rate was only 12%.
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Affiliation(s)
- Alena Furdova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, 826 01 Bratislava, Slovakia;
- Correspondence: ; Tel.: +421-248-234607
| | - Pavol Vesely
- Department of Ophthalmology, Faculty of Medicine, Comenius University, 826 01 Bratislava, Slovakia;
- VESELY Eye Clinic, 826 00 Bratislava, Slovakia
| | - Michal Trnka
- Department of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University, 821 01 Bratislava, Slovakia;
| | - Elena Novakova
- Department of Microbiology and Immunology, Jessenius Faculty of Medicine, Comenius University, 036 01 Martin, Slovakia;
| | - Michal Stubna
- Department of Ophthalmology, Faculty Hospital, 010 01 Zilina, Slovakia;
| | - Robert Furda
- Department of Information Systems, Faculty of Management, Comenius University, 820 05 Bratislava, Slovakia;
| | - Lubica Branikova
- Department of Ophthalmology, Faculty Hospital, 940 62 Nove Zamky, Slovakia;
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Abstract
The review presents the data on characteristic features of the new coronavirus infection caused by SARS-CoV-2 and the possibility of its transmission through the eye surface and lacrimal fluid, analyzes the information on eye damage caused by COVID-19, and provides the results of a systematic meta-analysis on the subject. The author describes the system for organizing ophthalmological care in the settings of unfavorable epidemiological situation associated with the COVID-19 pandemic, and considers the preventive measures of infection transmission between patients and medical personnel. The article also gives recommendations for sterilizing medical equipment.
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Affiliation(s)
- N I Kurysheva
- Medical-Biological University of Innovation and Continuing Education of the A.I. Burnazyan Federal Medical and Biophysical Center, Moscow, Russia.,Ophthalmological Center of the Federal Medical-Biological Agency, Moscow, Russia
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7
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Yan Y, Zeng B, Zhang Z, Hu C, Yan M, Li B, Zhang X, Chen X. Detection of SARS-CoV-2 in Simultaneously Collected Tear and Throat Swab Samples from the Patients with 2019- new SARS-CoV-2 Infection Disease: A Single Center Cross-sectional Study. Ophthalmic Epidemiol 2021; 28:369-375. [PMID: 33491542 DOI: 10.1080/09286586.2021.1875011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objecive: This study aimed to evaluate whether Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can be detected in the tears in the eyes of Coronavirus Disease 2019 (COVID-2019) infected patients and compare the detection consistency of two simultaneously collected samples, from the tears and throat swabs.Methods: A total of 35 COVID-2019 patients were included in this cross-sectional case series study. Throat samples from all enrolled patients were collected with sampling swab, and simultaneously, tear samples were collected with sampling swab from 9 patients (No.1-9) and with Schirmer's strip from the remaining patients (No.10-35) (bilateral eyes for all patients). Sample collecting and testing were performed in three separate time points: first from patients No.1-9, second from patients No.10-29, and third from patients No. 30-35. Reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay was performed.Results: Among enrolled patients, 29 (No.1-29) had mild or moderate clinical symptoms and 6 (No.30-35) had severe symptoms. The mean time interval from the sample collection day to diagnosis confirmation day was 9.71 ± 6.50 days (ranged from 3 to 29 days). None of the patients had conjunctivitis. Nineteen out of 35 (54.3%) throat samples presented positive Rt-PCR results. Three (no.13,21,31) out of 35 (8.6%) tear samples presented positive RT-PCR results. Two (no.21, 31) of these three patients were throat swab positive and one (No. 13) was negative. The consistency analysis indicated that tears and throat samples showed poor consistency (Kappa = -0.009, P = .9).The cycle threshold value (Ct-value) of tear samples collected by sampling swab was significantly higher than that by Schirmer's strip (t = 2.288, P = .03).Conclusion: In spite of the low SARS-CoV-2 positive detection rate of tear samples from COVID-2019 patients, we cannot fully rule out the transmission by ocular surface. Whether tear testing can be used as an aid in judging of SARS-CoV-2 infection need further investigation.
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Affiliation(s)
- Ying Yan
- Department of Ophthalmology, Central Theater General Hospital, Wuhan, China
| | - Bo Zeng
- Department of Ophthalmology, Central Theater General Hospital, Wuhan, China
| | - Zhang Zhang
- Laboratory of Vaccine and Antibody Engineering, Beijing Institute of Biotechnology, Beijing, China
| | - Cheng Hu
- Department of Ophthalmology, Central Theater General Hospital, Wuhan, China
| | - Ming Yan
- Department of Ophthalmology, Central Theater General Hospital, Wuhan, China
| | - Bixi Li
- Department of Anesthesiology, Central Theater General Hospital, Wuhan, China
| | - Xiaopeng Zhang
- Laboratory of Vaccine and Antibody Engineering, Beijing Institute of Biotechnology, Beijing, China
| | - Xiao Chen
- Department of Ophthalmology, Central Theater General Hospital, Wuhan, China
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8
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Khanna RC, Garg P, Vaddavalli PK, Fernandes M, Rath S, Nayak S, Narayanan R, Pappuru RR, Kaliki S, Das AV, Sharma S, Jalali S. Response of L V Prasad Eye Institute to COVID-19 outbreak in India: experience at its tertiary eye care centre and adoption to its Eye Health Pyramid. Int J Ophthalmol 2021; 14:1-9. [PMID: 33469477 DOI: 10.18240/ijo.2021.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023] Open
Abstract
AIM To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India. METHODS Our responses are based on the principles of social distancing, hand hygiene, respiratory etiquettes, surface disinfection protocol, and rational use of appropriate personal protective equipment (PPE). We describe our response in terms of administrative controls, clinical protocols, staff protection, environmental controls, and social distancing measures. We also discuss our communication strategies and monitoring systems, to ensure compliance to protocols. RESULTS Administrative control is mainly related to formation of task force and its functions. Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient, Inpatient and Operating Room. Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home, and use of PPE. Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital. In addition, there are systems for communication as well as monitoring compliance to protocols. CONCLUSION We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel, and their patients across the world.
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Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500030, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,School of Optometry and Vision Science, University of New South Wales, Sydney 2033, Australia.,University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Prashant Garg
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Pravin K Vaddavalli
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Merle Fernandes
- Grandhi Mallikarjun Rao Varalakshmi Campus, L V Prasad Eye Institute, Vishakhapatnam, Andhra Pradesh 530040, India
| | - Suryasnata Rath
- Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswara, Odisha 751024, India
| | - Sameera Nayak
- Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada 521134, India
| | - Raja Narayanan
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Rajeev Reddy Pappuru
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Swathi Kaliki
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Anthony Vipin Das
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India.,Department of eyeSmart EMR & AEye, L V Prasad Eye Institute 500034, India
| | - Savitri Sharma
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Subhadra Jalali
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
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9
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Abdul-Kadir MA, Lim LT. Human coronaviruses: ophthalmic manifestations. BMJ Open Ophthalmol 2020; 5:e000630. [PMID: 33195813 PMCID: PMC7607601 DOI: 10.1136/bmjophth-2020-000630] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/17/2020] [Accepted: 10/25/2020] [Indexed: 01/08/2023] Open
Abstract
The 2019 novel coronavirus which causes severe acute respiratory syndrome (SARS) known as SARS-CoV-2 still remains as a global pandemic since its discovery and continues to spread across the world, given how highly contagious the virus is. We reviewed various articles that explore eye involvement in COVID-19 and other human coronaviruses, its human manifestations in comparison to animal studies and potential mechanism of viral entry into the eye surface. Evidence of animal studies depicted various complications of coronaviruses infection into the eyes, in both anterior and posterior segments of the eye. Conjunctival inflammation remains uncommon in association with COVID-19, with other ophthalmic findings. The risk of transmission via the ocular surface remains likely low, though it is inarguably present based on preliminary finding of viral load in ocular samples and expression of ACE2 on the ocular surface. Testing the tears sample for diagnosing SARS-CoV-2 was unreliable due to limitations of the testing kits and conflicting evidence of the viral titre in the ocular samples. Further larger, more precise and specific studies are required to allow us to better understand the pattern of virulence underlying the associations of SARS-CoV-2 in the eye despite its rare occurrence. This review article aims to enhance better awareness among clinicians regarding ocular manifestations associated with COVID-19 and necessary precautions should be implemented to minimise the risk of person-to-person especially in the nosocomial setting.
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Affiliation(s)
- Mohd-Asyraaf Abdul-Kadir
- Ophthalmology Department, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Sarawak, Malaysia
| | - Lik Thai Lim
- Ophthalmology Department, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Sarawak, Malaysia
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10
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Amesty MA, Alió Del Barrio JL, Alió JL. COVID-19 Disease and Ophthalmology: An Update. Ophthalmol Ther 2020; 9:1-12. [PMID: 32445134 PMCID: PMC7243216 DOI: 10.1007/s40123-020-00260-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
The worldwide outbreak of the severe and acute respiratory coronavirus disease (COVID-19) caused by the coronavirus strain SARS-CoV-2 is currently the focal point of discussion due to the suffering this syndrome is causing to humanity. However, the ophthalmological implications of this syndrome has not yet been well described. Both eyes and tears as portals of entry and sources of contagion have been the subject of debate by many authors. The purpose of this review is to summarize the evidence currently available on COVID-19 and its ocular implications and manifestations, in both animals and humans, with the aim to facilitate prevention and educate the ophthalmological community on this subject. A review of the literature revealed that the results of some studies suggest that ocular symptoms commonly appear in patients with severe COVID-19 pneumonia and that it is possible to isolate the virus from the conjunctival sac of these patients. Conjunctivitis is not a common manifestation of the disease, but contact with infected eyes could be one route of transmission. Consequently, ophthalmologists need to have correct prevention strategies in place. Some guidelines regarding the prevention and management of ophthalmology clinics are reviewed. However, well-designed trials should be conducted to rule out other ocular manifestations that may result from COVID-19 infection and to understand the transmission of the virus through the eyes.
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Affiliation(s)
- María A Amesty
- Oculoplastic Department, Vissum (Grupo Miranza), Alicante, Spain
| | - Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Grupo Miranza), Alicante, Spain
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Grupo Miranza), Alicante, Spain.
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain.
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Öncül H, Öncül FY, Alakus MF, Çağlayan M, Dag U. Ocular findings in patients with coronavirus disease 2019 (COVID-19) in an outbreak hospital. J Med Virol 2020; 93:1126-1132. [PMID: 32776614 PMCID: PMC7436579 DOI: 10.1002/jmv.26412] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to investigate the ocular findings observed in patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 and to present the relationship between ocular involvement, systemic findings, and laboratory results. MATERIAL AND METHODS This cross-sectional study was carried out between 1 May and 30 June 2020. The study included 359 patients diagnosed with COVID-19 and assessed by clinical evaluation, nasopharyngeal polymerase chain reaction, and lung computed tomography. RESULTS One hundred ninety-seven (54.9%) of the patients were male and 162 (45.1%) were female. The mean age of the patients was 58.5 years (20-91). Two hundred ninety-four (81.9%) patients were treated in the inpatient clinic and 65 (18.1%) patients were treated in the intensive care unit. Various ocular diseases were observed in 16 (4.5%) of the patients. Although the rate of ocular disease was 12 out of 294 (4.1%) in patients followed up in the inpatient clinic, this rate was 4 out of 65 (6.2%) in intensive care patients. There was no systemic problem in one patient, in whom conjunctival hyperemia was the first and only reason for admission to the hospital. Four patients followed up in the inpatient clinic had conjunctivitis at the time of admission, and conjunctivitis occurred in three patients during hospitalization. Subconjunctival hemorrhage occurred in five patients and vitreous hemorrhage in one patient. CONCLUSION Ocular diseases are uncommon in COVID-19 patients but may occur during the first period of the disease or during follow-up. Ocular diseases may be the initial or only sign of COVID-19 infection.
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Affiliation(s)
- Hasan Öncül
- Department of Ophthalmology, University of Health Scıences Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
| | - Fatma Y Öncül
- Department of Internal Medicine, University of Health Scıences Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
| | - Mehmet F Alakus
- Department of Ophthalmology, University of Health Scıences Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
| | - Mehtap Çağlayan
- Department of Ophthalmology, University of Health Scıences Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
| | - Umut Dag
- Department of Ophthalmology, University of Health Scıences Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
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Marmamula S, Niranjan Kumar Y, Rajashekar V, Mettla AL, Vemuri JPS, Rathi VM, Khanna RC. Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India. Indian J Ophthalmol 2020; 68:1311-1315. [PMID: 32587156 PMCID: PMC7574086 DOI: 10.4103/ijo.ijo_1417_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre; Wellcome Trust/Department of Biotechnology India Alliance Research Fellow, L V Prasad Eye Institute, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Yanamala Niranjan Kumar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, Hyderabad, Telangana, India
| | - Varda Rajashekar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, Hyderabad, Telangana, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, Hyderabad, Telangana, India
| | - Joji Prasad Satya Vemuri
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, Hyderabad, Telangana, India
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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13
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Zimmerman K, Kearns F, Tzekov R. Natural protection of ocular surface from viral infections - A hypothesis. Med Hypotheses 2020; 143:110082. [PMID: 32679424 PMCID: PMC7346787 DOI: 10.1016/j.mehy.2020.110082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/04/2020] [Indexed: 01/08/2023]
Abstract
A pandemic outbreak of a viral respiratory infection (COVID-19) caused by a coronavirus (SARS-CoV-2) prompted a multitude of research focused on various aspects of this disease. One of the interesting aspects of the clinical manifestation of the infection is an accompanying ocular surface viral infection, viral conjunctivitis. Although occasional reports of viral conjunctivitis caused by this and the related SARS-CoV virus (causing the SARS outbreak in the early 2000s) are available, the prevalence of this complication among infected people appears low (~1%). This is surprising, considering the recent discovery of the presence of viral receptors (ACE2 and TMPRSS2) in ocular surface tissue. The discrepancy between the theoretically expected high rate of concurrence of viral ocular surface inflammation and the observed relatively low occurrence can be explained by several factors. In this work, we discuss the significance of natural protective factors related to anatomical and physiological properties of the eyes and preventing the deposition of large number of virus-loaded particles on the ocular surface. Specifically, we advance the hypothesis that the standing potential of the eye plays an important role in repelling aerosol particles (microdroplets) from the surface of the eye and discuss factors associated with this hypothesis, possible ways to test it and its implications in terms of prevention of ocular infections.
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Affiliation(s)
- Keith Zimmerman
- Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - Fiona Kearns
- Department of Chemistry, University of South Florida, Tampa, FL, USA
| | - Radouil Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, FL, USA; Department of Pharmaceutical Sciences, University of South Florida, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA.
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14
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Khanna RC, Honavar SG, Metla AL, Bhattacharya A, Maulik PK. Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India. Indian J Ophthalmol 2020; 68:994-998. [PMID: 32461412 PMCID: PMC7508077 DOI: 10.4103/ijo.ijo_1458_20] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India. Methods: An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9). Results: In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses. Conclusion: A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.
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Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, India
| | - Asha Latha Metla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | | | - Pallab K Maulik
- Deputy Director and Director of Research, George Institute for Global Health India, New Delhi, India; Associate Professor, University of New South Wales, Sydney, Australia; Professor, Prasanna School of Public Health, Manipal, Karnataka, India
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15
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Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
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16
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Seah I, Agrawal R. Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals. Ocul Immunol Inflamm 2020; 28:391-395. [PMID: 32175797 PMCID: PMC7103678 DOI: 10.1080/09273948.2020.1738501] [Citation(s) in RCA: 410] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus - 2 (SARS-CoV-2) emerged from China. This virus causes the coronavirus disease 2019 (COVID-19). Since then, there have been anecdotal reports of ocular infection. The ocular implications of human CoV infections have not been widely studied. However, CoVs have been known to cause various ocular infections in animals. Clinical entities such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been documented in feline and murine models. In this article, the current evidence suggesting possible human CoV infection of ocular tissue is reviewed. The review article will also highlight animal CoVs and their associated ocular infections. We hope that this article will serve as a start for further research into the ocular implications of human CoV infections.
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Affiliation(s)
- Ivan Seah
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,NHS Foundation Trust, Moorfields Eye Hospital, London, UK.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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Abstract
Respiratory viruses (including adenovirus, influenza virus, respiratory syncytial virus, coronavirus, and rhinovirus) cause a broad spectrum of disease in humans, ranging from mild influenza-like symptoms to acute respiratory failure. While species D adenoviruses and subtype H7 influenza viruses are known to possess an ocular tropism, documented human ocular disease has been reported following infection with all principal respiratory viruses. In this review, we describe the anatomical proximity and cellular receptor distribution between ocular and respiratory tissues. All major respiratory viruses and their association with human ocular disease are discussed. Research utilizing in vitro and in vivo models to study the ability of respiratory viruses to use the eye as a portal of entry as well as a primary site of virus replication is highlighted. Identification of shared receptor-binding preferences, host responses, and laboratory modeling protocols among these viruses provides a needed bridge between clinical and laboratory studies of virus tropism.
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Affiliation(s)
- Jessica A Belser
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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18
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Abstract
Severe acute respiratory syndrome (SARS) is caused by a coronavirus (CoV), SARSCoV. SARS-CoV belongs to the family Coronaviridae, which are enveloped RNA viruses in the order Nidovirales. Global research efforts are continuing to increase the understanding of the virus, the pathogenesis of the disease it causes (SARS), and the “heterogeneity of individual infectiousness” as well as shedding light on how to prepare for other emerging viral diseases. Promising drugs and vaccines have been identified. The milestones achieved have resulted from a truly international effort. Molecular studies dissected the adaptation of this virus as it jumped from an intermediary animal, the civet, to humans, thus providing valuable insights into processes of molecular emergence.
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Affiliation(s)
- Tommy R Tong
- Department of Pathology, Princess Margaret Hospital, Laichikok, Kowloon, Hong Kong, China
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