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PURPOSE: To describe composite multicolour (MC) imaging features along with the monocoloured fundus reflectance images in active and resolving stages of post-fever retinitis (PFR). METHODS: Retrospective image analysis of cases of PFR who underwent dilated retinal clinical examination followed by optical coherence tomography and MC imaging. RESULTS: Twenty-five eyes of 18 patients diagnosed with PFR were included. There were 11 males and 7 females. Mean age of patients was 30.63 years. The retinitis lesion appeared bright white on MC image and white mainly on blue and green reflectance images during the active stages of PFR. The lesion appeared dull-grey to greyish white during the resolving stages and as dull-green in resolved cases. The active stages showed the presence of intraretinal/subretinal fluid which appeared as green colour on MC images and less green to normal during resolving stages. Hard exudates were seen as bright yellow- or orange-coloured spots on MC image during the resolving stages of the disease. CONCLUSION: The different stages of PFR show different colour on multicolour image and different reflectance patterns on individual colour reflectance channels. Hence, multimodal fundus imaging with different wavelength can be helpful for differentiation of activity in PFR.
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Retinite , Tomografia de Coerência Óptica , Adulto , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Retinite/diagnóstico , Retinite/etiologia , Estudos RetrospectivosRESUMO
PURPOSE OF REVIEW: Ocular manifestations of leprosy do occur despite advances in the areas of leprosy research. Understanding the nuances in the domain shall guide the clinician for effective patient-centered care. RECENT FINDINGS: Despite the existence of microbiologic cure for leprosy, ocular manifestations of this disease do occur. Advances in genetic and genomic studies have better characterized the interaction that the bacteria has with the host. The ocular features vary with the spectrum of the disease. Its careful correlation can help to predict the bacillary load of the patient. Investigations are particularly relevant in multibacillary cases. The WHO suggests a treatment duration longer than the 2 years in ocular involvement. SUMMARY: The isolation of lepra bacilli from the iris biopsy in negative skin smear patients and multidrug therapy completion highlights the potential role of bactericidal agents in the planned intraocular treatment. Lepra reactions need careful titration of oral steroids and appropriate antibacterial agents. Advances in phacoemulsification with in the bag implantation of intraocular lenses is a game changer in the management of the most common cause of blindness of leprosy. Advances in vaccine research in leprosy are promising.
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Oftalmopatias , Hanseníase , Animais , Biópsia , Quimioterapia Combinada , Oftalmopatias/tratamento farmacológico , Humanos , Lentes Intraoculares , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Hanseníase/patologia , FacoemulsificaçãoRESUMO
Antibiotics such as fluoroquinolones (FQLs) are commonly used to treat ocular infections but are also known to cause dermal melanocyte toxicity. The release of dispersed pigments from the iris into the aqueous humor has been considered a possible ocular side effect of the systemic administration of FQLs such as Moxifloxacin, and this condition is known as bilateral acute iris transillumination (BAIT). Bilateral acute depigmentation of iris (BADI) is a similar condition, with iris pigment released into the aqueous, but it has not been reported as a side effect of FQL. Iris pigments are synthesized by the melanogenic enzyme tyrosinase (TYR) and can be detected but not quantified by using slit-lamp biomicroscopy. The correlation between dispersed pigments in the aqueous and the extent of melanocyte toxicity due to topical antibiotics in vivo is not well studied. Here, we aimed to study the effect of topical FQLs on iris tissue, the pigment release in the aqueous humor and the development of clinically evident iris atrophic changes. We evaluated this process by measuring the activity of TYR in the aqueous humor of 82 healthy eyes undergoing cataract surgery following topical application of FQLs such as Moxifloxacin (27 eyes, preservative-free) or Ciprofloxacin (29 eyes, with preservative) or the application of non-FQL Tobramycin (26 eyes, with preservative) as a control. In addition, the patients were questioned and examined for ocular side effects in pre- and post-operative periods. Our data showed a significantly higher mean TYR activity in the aqueous humor of Ciprofloxacin-treated eyes compared to Moxifloxacin- (preservative free, p < 0.0001) or Tobramycin-treated eyes (p < 0.0001), which indicated that few quinolones under certain conditions are toxic to the iris melanocytes. However, the reduced TYR activity in the aqueous of Moxifloxacin-treated eyes was possibly due to the presence of a higher drug concentration, which inhibits TYR activity. Consistently, immunoblotting analysis of the aqueous humor from both Ciprofloxacin- and Moxifloxacin-treated eyes showed the presence of soluble TYR enzyme, thus reflecting its toxicity to iris melanocytes and corresponding to its activity in the aqueous humor. Intriguingly, none of these patients developed any clinically appreciable ocular side effects characteristic of BAIT or BADI. Overall, our results suggest that topical antibiotics cause different levels of iris melanocyte toxicity, releasing dispersed pigments into the aqueous humor, which can be measured through TYR enzyme activity. Hence, we conclude that topical FQLs may cause subclinical toxicity to the iris melanocytes but may not be the sole cause of the development of BAIT or BADI.
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Humor Aquoso/enzimologia , Fluoroquinolonas/efeitos adversos , Iris/patologia , Melanócitos/efeitos dos fármacos , Monofenol Mono-Oxigenase/metabolismo , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Cromatografia Líquida de Alta Pressão , Relação Dose-Resposta a Droga , Feminino , Fluoroquinolonas/administração & dosagem , Humanos , Iris/efeitos dos fármacos , Iris/metabolismo , Masculino , Melanócitos/metabolismo , Melanócitos/patologia , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos ProspectivosRESUMO
A woman in her late 30s presented with sudden diminution of vision, redness and pain in the right eye (OD) of 10 days' duration. Best corrected visual acuity (BCVA) was 20/160 in OD and 20/20 in the left eye (OS). Anterior segment of OD showed keratic precipitates, flare 3+, cells 2+ and a festooned pupil. Vitreous haze and cells were seen in OD. Frosted branch angiitis (FBA) was seen in all quadrants in OD and old Toxoplasma scar was seen in both eyes. Serum toxoplasma immunoglobulin G (IgG) was positive and IgM negative, and PCR of an aqueous humour sample was negative for Toxoplasma She was diagnosed with toxoplasa retinochoroiditis in OD and treated with intravitreal clindamycin injections, oral anti-Toxoplasma antibiotics and steroids. Three months later, her BCVA in OD was 20/40 with resolving inflammation. She presented 2 months later with a new focus of retinochoroiditis without FBA and an old Toxoplasma scar.
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Coriorretinite , Toxoplasma , Toxoplasmose Ocular , Humanos , Feminino , Coriorretinite/tratamento farmacológico , Coriorretinite/diagnóstico , Coriorretinite/parasitologia , Toxoplasmose Ocular/diagnóstico , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/complicações , Toxoplasma/isolamento & purificação , Adulto , Imagem Multimodal , Vasculite/tratamento farmacológico , Vasculite/diagnóstico , Vasculite/complicações , Acuidade Visual , Clindamicina/uso terapêutico , Clindamicina/administração & dosagem , Tomografia de Coerência Óptica , Antibacterianos/uso terapêuticoRESUMO
ABSTRACT: This report describes a challenging case of refractory acute retinal necrosis (ARN) with peripapillary choroiditis as the initial presenting sign. Imaging studies confirmed multifocal choroidal lesions and noted the novel sign of vertical hyper-reflective strips (VHRS) in the outer nuclear layer. Initial treatment with acyclovir and valacyclovir failed, and involvement of the other eye suggested a resistant variant of varicella zoster virus. High-dose oral famciclovir therapy resulted in rapid resolution of ARN in both eyes. This case highlights the rare occurrence of choroiditis, the novel finding of VHRS, and the potential utility of high-dose oral famciclovir in treating refractory ARN.
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Multiple evanescent white dot syndrome (MEWDS) is a rare form of posterior uveitis characterized by involvement in the posterior pole and mid-periphery. A viral etiology that provokes an immune-mediated response has been hypothesized to be the inciting factor of the pathology. Recently, there has been an increase in the literature regarding new-onset uveitis and reactivation of previously diagnosed cases of uveitis following COVID-19 vaccinations. The COVID-19 vaccination has been speculated to trigger an immunomodulatory shift in recipients, resulting in an autoimmune event. MEWDS following COVID-19 vaccination was reported in 31 patients. It was most commonly observed following the first dose, affecting 15 patients, and least commonly after the booster dose, in only one patient. MEWDS-like disease following anti-SARS-CoV-2 vaccinations was reported the most in 16 cases after the Pfizer-BioNTech vaccination (BNT162b2 mRNA). Most of these cases had Primary MEWDS without any previous history of a similar event in the past.
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COVID-19 , Síndrome dos Pontos Brancos , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Vacinas contra COVID-19/efeitos adversos , Angiofluoresceinografia/métodos , Fundo de Olho , Tomografia de Coerência Óptica , Uveíte Posterior/diagnóstico , Uveíte Posterior/virologia , Síndrome dos Pontos Brancos/diagnósticoRESUMO
PURPOSE: To study the choroidal thickness (CT) and central macular thickness (CMT) in post-fever retinitis (PFR) and their correlation with visual acuity and treatment. METHODS: A retrospective, observational study of patients presenting with PFR from 2013 to 2021 and with spectral domain optical coherence tomography (SD-OCT) (Heidelberg®, SpectralisTM, Heidelberg, Germany) images were included. The CT and CMT were measured at presentation and at the final visit. The CT was measured subfoveally and at points 2000 µm superior, inferior, medial, and lateral from the fovea using the caliper tool. RESULTS: Seventy-nine eyes of 65 patients were included for this study. The mean age was 39.03 (±16.00) years with female preponderance of 53.84% (n = 35). Mean follow-up duration was 30 days. Mean CT at presentation and at follow-up was 254.12 µm and 241.51 µm, respectively. CT was decreased in majority of the eyes 67.1% (n = 53) from their baseline value. Mean CMTs at presentation and final visit were 454.8 µm and 223.7 µm, respectively. Best corrected visual acuity had a positive correlation with CMT (r = 0.340; P = 0.002) and negligible correlation with CT. A significant decrease in the mean CT was noted in patients who received doxycycline either alone or in combination with a steroid as compared to those who did not receive any treatment (P < 0.001). The significance of which is unknown presently. CONCLUSION: CMT has a greater role in determining the final visual outcome than CT. CT can be reduced post-treatment with no effect on vision.
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Corioide , Macula Lutea , Retinite , Tomografia de Coerência Óptica , Acuidade Visual , Humanos , Feminino , Estudos Retrospectivos , Masculino , Tomografia de Coerência Óptica/métodos , Adulto , Corioide/patologia , Corioide/diagnóstico por imagem , Acuidade Visual/fisiologia , Macula Lutea/patologia , Macula Lutea/diagnóstico por imagem , Retinite/diagnóstico , Retinite/tratamento farmacológico , Retinite/fisiopatologia , Seguimentos , Pessoa de Meia-Idade , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Adulto Jovem , Antibacterianos/uso terapêutico , AdolescenteRESUMO
PURPOSE: To study cases of Fuchs' uveitis (FU) diagnosed as uveitis other than FU at initial visits. METHODS: A retrospective, observational chart review. Details of clinical presentation, initial diagnosis, treatment details, and follow-up before and after the diagnosis of FU was studied. RESULT: Twenty eyes of 19 patients finally diagnosed with FU. Mean total follow-up was 39 months (range: 3-120 months, median: 30 months) and follow-up after diagnosis of FU was 18 months (range: 0-84 months, median: 11 months). Most of the cases were diagnosed with anterior plus intermediate uveitis at the presentation (n = 8, 42.1%) and received steroid treatment. Keratic precipitates (KPs) typical of FU developed after mean 5.4 months of presentation (range: 1-18 months, median: 2 months). Altered iris pattern was noted after 17 months of presentation (range: 2-70 months, median: 8.5). Vitritis of grades 1-2 was present in all eyes. Overlap of uveitis of other etiology (retinal vasculitis, presumed tubercular intermediate uveitis) was found in three patients. Systemic immune disease (systemic lupus erythematosus, pulmonary sarcoidosis) was present in two patients. No treatment for the ocular inflammation was given after the diagnosis of FU in any patient and no change in the pattern of FU was observed during further follow-up. CONCLUSION: Evolving FU may lead to misdiagnosis and mismanagement. We suggest a conservative approach, withholding steroid treatment, allowing FU to evolve, in otherwise asymptomatic patients with white eye, mild to moderate anterior chamber (AC) and vitreous inflammation, absent posterior synechiae and normal fundus examination or fundus examination suggestive of resolved uveitis.
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Acuidade Visual , Humanos , Estudos Retrospectivos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Seguimentos , Diagnóstico Diferencial , Idoso , Adulto Jovem , Adolescente , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico , Criança , Fundo de Olho , Angiofluoresceinografia/métodosRESUMO
PURPOSE: To compare various ocular thermography parameters in posterior scleritis (PS), choroiditis (choroidal granuloma [CG], Vogt-Koyanagi-Harada [VKH] syndrome), central serous chorioretinopathy (CSCR), and healthy controls. METHODS: This retrospective, observational, comparative study evaluated cases undergoing ocular thermography between April 2017 and October 2023. The study groups included cases of PS, CG, and VKH, while the control group comprised CSCR cases and healthy individuals. Various thermography parameters were assessed, which were as follows: Ocular surface temperature (OST), central corneal temperature (CCT), average scleral temperature (ST), nasal scleral temperature (nST), temperature difference between both the eyes (∆t), and difference between scleral and corneal temperatures (ST - CCT, nST - CCT). RESULTS: It was found that ∆t was significantly higher in the PS group compared to the CG ( P = 0.005), CSCR ( P = 0.0001), and control groups (dilated control: P =0.006, undilated control: P = 0.0001). ST - CCT and nST - CCT were significantly higher in the undilated control and CSCR groups and significantly lower in the PS group. ST - CCT and nST - CCT showed less difference in the affected eyes compared to contralateral healthy eyes of PS and CG cases. OST, CCT, ST, and nST displayed statistically insignificant differences across all groups. CONCLUSION: It is advisable to focus on temperature differences between the affected and healthy eyes, or the difference between the central corneal and scleral temperature of the affected eye, utilizing parameters such as ∆t, ST - CCT, and nST - CCT. These composite parameters offer a more effective approach than individual measurements like OST, CCT, ST, and nST. Thermography can serve as a screening tool to suspect and differentiate PS.
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Corioidite , Esclera , Esclerite , Termografia , Humanos , Esclerite/diagnóstico , Esclerite/fisiopatologia , Estudos Retrospectivos , Termografia/métodos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Esclera/fisiopatologia , Corioidite/diagnóstico , Corioidite/fisiopatologia , Temperatura Corporal/fisiologiaRESUMO
PURPOSE: To report a case of seroreversion in a patient with HIV-associated bilateral CMV retinitis and the challenges associated with detection of this phenomenon in late stages of HIV. METHOD: Retrospective single case report. RESULTS: The clinical picture of the patient on presentation was suggestive of viral retinitis. PCR confirmed a diagnosis of CMV retinitis. Serology for HIV-1 & 2 was negative. A viral load of HIV and CD-4 count confirmed his sero status to be positive for HIV. Improvement in visual acuity and slow resolution of the lesion was noted with both anti-viral for CMV and HIV. A repeat HIV-1 testing was positive with an improvement in CD4 count. CONCLUSION: In highly suspicious individual, with a negative serology (post screening test) for HIV, the disease status should be confirmed by testing the individual for HIV viral load and CD4 count.
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PURPOSE: To report a case of mumps-associated outer retinitis, diagnostic, and therapeutic challenges associated with the disease. METHOD: Retrospective observational case report. RESULTS: An 8-year-old male child on presentation had a history of mumps infection following which he developed outer retinitis. Upon evaluation, he had bilateral multifocal perivascular cerebriform retinitis. MRI revealed increased uptake of contrast by bilateral parotid gland and with serum mumps IgM and IgG antibodies being raised, a diagnosis of mumps associated outer retinitis was made. In terms of treatment post-systemic steroid therapy, hyperbaric oxygen therapy was tried as a rescue therapy in this patient. Improvement in vision was noted in the left eye more than the right eye. CONCLUSION: Hyperbaric oxygen therapy can be considered as an additional therapy to systemic steroid therapy in mumps associated retinitis. In such a situation, since there is no specific antiviral drug available for mumps infection, the most effective treatment is prevention by vaccination.
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Acute retinal necrosis is a progressive intraocular inflammatory syndrome characterized by diffuse necrotizing retinitis that can lead to a poor visual outcome, mainly from retinal detachment. The antiviral treatment approach for acute retinal necrosis varies as there are no established guidelines. We summarize the outcomes of acute retinal necrosis with available antiviral treatments. Electronic searches were conducted in PubMed/MEDLINE, EMBASE, Scopus, and Google Scholar for interventional and observational studies. Meta-analysis was performed to evaluate the pooled proportion of the predefined selected outcomes. This study was registered in PROSPERO (CRD42022320987). Thirty-four studies with a total of 963 participants and 1,090 eyes were included in the final analysis. The estimated varicella-zoster virus and herpes simplex virus polymerase chain reaction-positive cases were 63% (95% CI: 55-71%) and 35% (95% CI: 28-42%), respectively. The 3 main antiviral treatment approaches identified were oral antivirals alone, intravenous antivirals alone, and a combination of systemic (oral or intravenous) and intravitreal antivirals. The overall pooled estimated proportions of visual acuity improvement, recurrence, and retinal detachment were 37% (95% CI: 27-47%), 14% (95% CI: 8-21%), and 43% (95% CI: 38-50%), respectively. Patients treated with systemic and intravitreal antivirals showed a trend towards better visual outcomes than those treated with systemic antivirals (oral or intravenous) alone, even though this analysis was not statistically significant (test for subgroup differences P = 0.83).
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Infecções Oculares Virais , Descolamento Retiniano , Síndrome de Necrose Retiniana Aguda , Humanos , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Antivirais/uso terapêutico , Aciclovir/uso terapêutico , Infecções Oculares Virais/tratamento farmacológico , Estudos RetrospectivosRESUMO
A 36-year-old Asian Indian male presented with redness and pain in his right eye of 1 week duration. He was diagnosed to have right acute anterior uveitis and had a history of being admitted at a local hospital for dengue hepatitis a month earlier. He had been on adalimumab 40 mg three weekly once and oral methotrexate 20 mg/week for human leucocyte antigen (HLA) B27 spondyloarthropathy and recurrent anterior uveitis. Our patient had re-activation of his anterior chamber inflammation on three distinct occasions: first, 3 weeks following recovery from coronavirus disease 2019 (COVID-19), the second after the second dose of COVID-19 vaccination, and the third after recovery from dengue fever-associated hepatitis. We propose molecular mimicry and bystander activation as the postulated mechanisms for the re-activation of his anterior uveitis. In conclusion, patients with auto-immune diseases can have recurrent ocular inflammation following COVID-19 or its vaccination or dengue fever as seen in our patient. The anterior uveitis is usually mild and responds to topical steroids. Additional immuno-suppression may not be needed. Mild ocular inflammation following vaccination should not deter individuals from getting COVID-19 vaccination.
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COVID-19 , Dengue , Hepatite A , Hepatite , Uveíte Anterior , Uveíte , Humanos , Masculino , Adulto , Vacinas contra COVID-19/efeitos adversos , Uveíte Anterior/diagnóstico , Uveíte Anterior/etiologia , Inflamação , Antígeno HLA-B27 , Vacinação/efeitos adversos , Dengue/complicações , Dengue/diagnósticoRESUMO
Purpose: The objective was to study the positivity of the Weil-Felix test (WFT) in epidemic retinitis (ER) during the course of the disease. Methods: This is a retrospective, observational case series of patients diagnosed with ER and presented to a tertiary eye care hospital in south India. Patients with positive WFT at the presentation, and who underwent a follow-up WFT during or after the resolution of ER were studied from September 2019 to March 2022. Patient's demographics, timings of clinical presentation and resolution, and investigation details with a special focus on WFT positivity and its duration were noted. Results: Sixteen patients were studied. Patients presented after 5 weeks of the fever (range: 2-12 weeks, median: 4). After 1-2 months, WFT was still positive in eight patients (50%). Only in one patient titers increased after 1 month, while in others, the titers decreased (n = 11) or remained the same (n = 4). Repeated tests in those patients (n = 6) after 3-4 months turned negative. Resolution of ER was seen at 1.35 months (range: 1-3 months) after the presentation. The mean duration for WFT to turn negative was 2 months from the presentation (range: 1-4 months) or 3.2 months of the fever (range: 1.5-6 months). Conclusion: In contrast to the reported physician's observation of increasing titers of WFT after rickettsial fever, ophthalmologists may observe decreasing WFT titers in ER. The clinical resolution of ER may precede the normalization of WFT. Follow-up WFT titers should be studied in larger series in confirmed cases of rickettsial-ER to validate the affordable and readily available WFT in India.
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Epidemias , Retinite , Rickettsia , Humanos , Estudos Retrospectivos , Retinite/epidemiologia , Índia/epidemiologia , FebreRESUMO
During the Coronavirus Disease 2019 (COVID-19) pandemic, we have witnessed increase in number of reports of a known uveitic entity being associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Causal relation is yet to be proven for many reports. Perhaps, occurrence of a previously known region-specific endemic disease or closely resembling manifestations of a known disease in a non-endemic region during the COVID-19 pandemic might suggest a causal relationship. Epidemic retinitis (ER) or post fever retinitis is such condition with geographic variation. Occurrence of ER or ER-like manifestations in a non-endemic country during the pandemic should instigate further studies to consider SARS-CoV-2 as a causative organism.
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COVID-19 , Coriorretinite , Pan-Uveíte , Retinite , Humanos , COVID-19/complicações , COVID-19/epidemiologia , SARS-CoV-2 , Pandemias , Retinite/diagnóstico , Pan-Uveíte/diagnósticoRESUMO
Characteristics and course of known seasonal diseases of pre-coronavirus disease (COVID-19) pandemic era may or may not change during the pandemic. Labelling COVID-19 as a novel etiology for those seasonal diseases or considering it as coinfection is debatable. Appropriate investigations are required to rule out previously known etiologies before correlating it with COVID-19. Epidemic retinitis (ER) or post fever retinitis is one such entity with seasonal variation. Multiple seropositivity for various organisms has been reported for ER during pre-pandemic era. This may significantly increase during the pandemic as the possibility of coinfection with COVID-19 is high. In the absence of gold-standard tests to exclude previously reported causes of ER, one should not undermine the possible coinfection before considering ER as post-COVID-19 syndrome. A study of incidence and pattern of seasonal variation of ER before and during the pandemic is needed before presumptively associating it with COVID-19.
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COVID-19 , Coinfecção , Retinite , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Coinfecção/epidemiologia , Síndrome de COVID-19 Pós-Aguda , Retinite/epidemiologia , PandemiasRESUMO
PURPOSE: Chikungunya is a re-emerging viral infection across the globe. The purpose of this article is to review the systemic and ophthalmic manifestations associated with chikungunya fever. METHOD: A review of literature was conducted using online databases. RESULTS: In this report, we have reviewed the presently available literature on uveitis caused by chikungunya and highlighted the current knowledge of its clinical manifestations, imaging features, laboratory diagnostics, and the available therapeutic modalities from the systemic and ophthalmic standpoint. CONCLUSIONS: Ocular involvement in chikungunya infection may occur at the time of systemic manifestations or it may occur as a delayed presentation many weeks after the fever. Treatment relies on a supportive therapy for systemic illness. Treatment of ocular manifestation depends on the type of manifestations and usually includes a combination of topical and oral steroids.
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PURPOSE: To present the clinical features of a rare case of varicella zoster infection following one dose of Coronavirus Disease 2019 (COVID-19) vaccination in an elderly Asian Indian male. METHODS: Retrospective observational case report. RESULTS: A 71-year-old gentleman presented to us with complaints of reduced vision associated with redness and pain in his right eye for 1 week. On examination he revealed a right eye pan uveitis picture with circumcorneal congestion, multiple fine keratic precipitates, anterior chamber cells and flare, vitritis and widespread areas of acute retinal necrosis. His left eye was within normal limits. Ten days prior to the presentation he had received the first dose of COVID-19 vaccine following which he had developed fever for 2 days that preceded the red eye. The patient's aqueous sample tested positive for varicella zoster virus (VZV) by nested polymerase chain reaction (PCR) method. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in reverse transcriptase polymerase chain reaction (RT-PCR) assay from the aqueous and also from the nasopharyngeal swab was negative. CONCLUSION AND SIGNIFICANCE: To the best of our knowledge this is the earliest description of a case that has a viral reactivation following COVID-19 vaccination. Elderly people with pre-existing comorbidities, may be at a risk of both primary coronavirus infection and unconceivable risk of aberrant immune reactions leading to a different virus infection or reactivation need to be kept in mind. We present a possible link between SARS-CoV-2 virus vaccination and varicella zoster reactivation in this patient.
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Vacinas contra COVID-19 , COVID-19 , Varicela , Herpes Zoster , Síndrome de Necrose Retiniana Aguda , Idoso , Humanos , Masculino , COVID-19/diagnóstico , Vacinas contra COVID-19/efeitos adversos , Herpesvirus Humano 3/genética , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/etiologia , Estudos Retrospectivos , SARS-CoV-2 , Vacinação/efeitos adversosRESUMO
Purpose: To study the impact of the novel coronavirus disease-2019 (COVID-19) pandemic on incidence, seasonal variation, clinical presentation, and disease outcome of epidemic retinitis (ER) and to compare clinical outcomes with positive and negative COVID-19 serology. Methods: This is a retrospective, observational study conducted at a tertiary eye care hospital from August 2020 to June 2022. A graph of ER cases against the month of presentation was compared with the graph of the COVID-19 pandemic in the same region. Cases presented before COVID-19 vaccination, with positive COVID-19 serology (Group 1) were compared with cases with negative serology (Group 2). Results: One hundred and thirty-two cases of ER were seen. The least number of cases were seen during and immediately after the peak of the pandemic (May 2021-August 2021). COVID-19 serology was positive in 13 (22 eyes)/60 (21.6%) unvaccinated cases. Along with COVID-19, positive serology for other ER etiologies was seen in 5/13 cases (38.4%). All patients received oral doxycycline with/without steroids. Groups 1 and 2 included 22 and 21 eyes of 13 cases each. Macular edema resolved in 43.6 and 32 days in groups 1 and 2, respectively. Retinitis resolved at 1 month in both groups. Corrected distant visual acuity was 20/50 and 20/70 at the presentation, which improved to 20/20 and 20/25 in groups 1 and 2, respectively. Mean and median follow-up was 6 months and 4.5 months, respectively, in both groups. No complications or recurrences were seen. Conclusion: No significant impact of the COVID-19 pandemic on ER was observed.