Severe COVID-19 and Retina: Are There Any Retinal Manifestations?

PURPOSE: To investigate whether there are retinal lesions associated with severe COVID-19. METHODS: We studied 232 symptomatic subjects aged 18 - 65 years who had severe COVID-19 and had received treatment. The evaluations included ophthalmological examinations, optical coherence tomography (OCT), imaging modalities with near infrared reflectance (NIR), fundus autofluorescence (FAF), and fundus photography (FP). RESULTS: The mean age of the patients was 49 years, and 67.6% of them were men. There were no findings of microhemorrhage, cotton wool spots (CWS), vitritis, or retinitis in the examination and imaging. CONCLUSIONS: This study indicates that retinal involvement as a complication associated with COVID-19 is questionable, although some reports have demonstrated a relationship that may occur secondary to existing systemic diseases.

Peripapillary choroidal thickness in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the peripapillary choroidal thickness of patients with chronic obstructive pulmonary disease (COPD) via enhanced depth imaging optical coherence tomography (EDI-OCT). MATERIALS AND METHODS: A total of 80 patients with COPD (80 eyes) and 50 control subjects (50 eyes) were enrolled. Choroidal scans and the retinal nerve fiber layer (RNFL) thickness were obtained for all eyes using OCT. RESULTS: The average peripapillary choroidal thickness measurements of the COPD group (147.58 ± 53.53 µm) were lower than the control group (160.84 ± 44.73 µm) (p = 0.068). Inferior segment thicknesses were significantly thinner than the other segments (p < 0.05). Subfoveal choroidal thickness and RNFL thickness measurements of the COPD group were also lower than those of the control group (p = 0.111). CONCLUSION: Hypoxia in COPD seems to affect the choroidal thickness. Thinning of the choroid may be attributed to increased vascular resistance and reduced blood flow in patients with COPD. The possible effects of the disease to the eye may be clarified through the role of the choroidal vasculature in the blood supply of the anterior optic nerve head.

Discrimination of Epithelial Face of Conjunctival Autograft in Pterygium Surgery with Fibrin Glue.

A 48-year-old male patient was operated for pterygium. During surgery, the autograft surface was lost because of sponge contact. Presumed epithelial face of the autograft subsequently was attached to the bare sclera with fibrin glue. It was observed that the center of the autograft was freely movable with sponge. This finding showed the inverse implantation of the autograft. Because the glue does not stick to intact corneal or conjunctival epithelium, free movement of the center of the autograft shows that the graft is inversely implanted.

Effect of nepafenac eye drops on pain associated with pterygium surgery.

OBJECTIVE: To assess the effects of nepafenac ophthalmic suspension 0.1% for control of pain in patients undergoing pterygium surgery. METHODS: This randomized, double-masked placebo-controlled study included 62 adults undergoing pterygium surgery. Patients were randomly assigned to receive nepafenac ophthalmic suspension 0.1% or balanced salt solution placebo. They were asked to assess the level of pain using an 11-point numeric rating scale at 6, 12, 24, 48, and 72 hr after surgery. Patients also were evaluated daily for the progression of corneal epithelial healing until complete closure was observed. RESULTS: Except at 72 hr after surgery, the patients reported significantly less pain in eyes receiving nepafenac than in eyes receiving placebo. There was no statistical difference between the two groups in corneal epithelial healing. CONCLUSIONS: Treatment with nepafenac ophthalmic suspension 0.1% significantly reduced postoperative pain compared with placebo after pterygium surgery.

The effect of rebreathing and hyperventilation on retinal and choroidal vessels measured by spectral domain optical coherence tomography.

OBJECTIVE: The purpose of this study was to examine the vasoreactivity in retina and choroid of the healthy eyes in response to experimentally altered partial arterial pressure of carbon dioxide (PaCO(2)) using a non-invasive technique, spectral domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: The study included non-smoking participants between 18 and 35 years of age, having visual acuity of 20/20 and with no systemic and ocular diseases. At baseline, the participants breathed room air (normocapnia). Hypocapnia was created with the help of hyperventilation; for this, the participants were instructed to draw deep and quick breaths, resulting one breathing cycle per 2 s. To create hypercapnia subjects rebreathed from a 5 l bag at least 3 min. Choroidal thickness and retinal artery diameter were measured at baseline, and hyperventilation and rebreathing conditions by SD-OCT. RESULTS: Twenty eyes of 20 healthy subjects were included in this study. Their mean age was 24.90 ± 5.32 years. Hyperventilation caused a significant reduction in choroidal thickness, compared with baseline, at all points; whereas rebreathing caused no significant change at all points. The mean diameters of the arteries were 151.80 ± 7.88 µm, with a significant decline to 148.90 ± 7.25 µm at hyperventilation condition and a significant increase to 153.50 ± 7.88 µm at rebreathing condition (p = 0.018, p = 0.043, respectively). CONCLUSION: This study demonstrated that, SD-OCT was a useful tool in measuring the ocular vascular response under hypercapnia and hypocapnia conditions. These findings may be helpful for further understanding the physiological nature of ocular blood flow and this preliminary study provides a basis for future studies.

Pharmacokinetics of intravenously administered tigecycline in eye compartments: an experimental study.

PURPOSE: The purpose of this study was to evaluate the ocular distribution of intravenously administered tigecycline in a rabbit uveitis model. METHODS: Tigecycline, which has a broad spectrum of activity against many gram-positive, gram-negative, and anaerobic organisms, was given intravenously to rabbits at 7 mg/kg of body weight starting 24 h after induction of uveitis by intravitreal endotoxin injection. Tigecycline concentrations were determined by high performance liquid chromatography-mass spectrometry (LC-MS/MS) assay in the aqueous humor, vitreous humor, and plasma 1, 3, 6, and 24 h after administration of a single dose. RESULTS: The maximum concentrations were found within 1 h after the end of the intravenously given tigecycline, and were 1,308.60 ± 301.76 ng/mL in plasma, 181.40 ± 51.32 ng/mL in vitreous humor and 145.00 ± 55.29 ng/mL in aqueous humor of the inflamed eye. After 24 h, no drug was detectable in the aqueous and vitreous of the normal eyes, whereas small amounts of drug were detectable in inflamed eyes and in plasma. CONCLUSIONS: Tigecycline did not reach therapeutically significant levels in the aqueous and the vitreous humor of rabbit eyes. The findings suggest a limited role for intravenously administered tigecycline in the treatment of bacterial endophthalmitis.

Antiangiogenic effect of itraconazole on corneal neovascularization: a pilot experimental investigation.

PURPOSE: To investigate the antiangiogenic effect of itraconazole for the prevention of experimentally induced corneal neovascularization and whether the efficacy depends on the route of administration. MATERIALS AND METHODS: Thirty-six rats were randomly divided into 6 groups with 6 rats in each group. Chemical cauterization of the cornea was performed using silver nitrate/potassium nitrate sticks, and the rats were subsequently treated daily with topical (10 mg/ml), subconjunctival (10 mg/ml) or intraperitoneal (19 mg/kg) itraconazole for 7 days. Control rats received topical, subconjunctival or intraperitoneal 0.9% saline. On the 8th day of the experiment, the rat corneas were photographed to determine the percentage area of the cornea covered by neovascularization. The maximum density of corneal neovascularization was determined by microscopy. RESULTS: The median percentage of corneal neovascularization for group 1 was 31.5% (95% confidence interval, 27.5-35.5%); in group 3, it was 32% (23.5-39.8%); in group 5, it was 47% (36.3-60.0%). The percentages of corneal neovascularization in groups 2, 4 and 6 (the control groups) were 70% (95% confidence interval, 60.7-77.3%), 69% (63.0-77.7%) and 68% (56.5-78.5%), respectively. The area of neovascularization was smaller after itraconazole treatment as compared to saline treatment. Further, the area of neovascularization was smaller after topical and subconjunctival administration than after intraperitoneal administration. Histological evaluation of the corneas showed the most extensive corneal neovascularization in the control group. No local or systemic adverse effects were seen from either treatment group. CONCLUSION: Itraconazole reduces corneal neovascularization shortly after chemical burn. However, a larger experimental study is necessary to confirm the data of this investigation.

Short-term impact of intravitreal ranibizumab injection on axial ocular dimension and intraocular pressure.

OBJECTIVE: To evaluate the short-term impact of intravitreal ranibizumab injection on axial ocular dimension (AOD) and intraocular pressure (IOP). METHODS: A total of 31 patients who received 0.05 mL intravitreal ranibizumab injection (IRI) for age-related macular degeneration and 30 healthy volunteers were enrolled in the study. AODs i.e. anterior chamber depth and axial length were measured with IOL Master and IOP with noncontact tonometer before and 5 min, 30 min and 1 day after the injection. RESULTS: Five minutes after the injection, mean IOP increased to 24.8 ± 9.5 (13-46) mmHg from 14.5 ± 2.3 (10-18) mmHg (p < 0.001). Thirty minutes after the injection, IOP decreased a mean level of 17.3 ± 4.1 (11-26) mmHg. The change in axial length and anterior chamber depth measurements did not reach a statistical significance across the time points (p > 0.05, for all values). There was no correlation between biometric measurements and IOP before (r = 0.016, p = 0.948 for axial length and r = -0.48 p = 0.075 for anterior chamber depth) and 5 min after IRI (r = 0.049, p = 0.835 for axial length and r = -0.219 p = 0.367 for anterior chamber depth). Measurements of control group taken across same time points did not reveal statistically significant differences (p > 0.05, for all measurements). CONCLUSION: Although IOP increases transiently after the intravitreal injection of 0.05 mL ranibizumab, axial length and anterior chamber depth are not affected by this amount of injection, and the increase in IOP after the injection seems to be irrelevant to AL and anterior chamber depth. Therefore, it is postulated that ranibizumab can be used safely in patients with age-related macular degeneration who have shallow anterior chamber and/or short axial length simultaneously.

Effect of mitomycin C on revision endoscopic dacryocystorhinostomy.

OBJECTIVE: The objectives of the study were to compare the outcome and success rate of revision endoscopic dacryocystorhinostomy (EN-DCR) with or without use of adjunctive mitomycin C (MMC) in cases with dacryocystorhinostomy (DCR) failure. METHODS: Thirty-six consecutive adult patients underwent revision EN-DCR. The patients were divided into 2 groups. In group 1 (18 patients), a neurosurgical cottonoid soaked in MMC at 0.5 mg/mL was placed at the osteotomy site for 5 minutes (using canalicular silicone intubation tube). In the other group (18 patients), standard endoscopic dacryocystorhinostomy technique was used without MMC (using canalicular silicone intubation tube). Successful DCR was defined as relief of symptoms (resolution of epiphora and absence of discharge) as demonstrated by saline irrigation at the last postoperative visit. RESULTS: The EN-DCR procedure with adjunctive MMC was successful in 16 (88.88%) cases. The mean follow-up was 11.5 months (7-19 months). No significant complications were encountered. In the control group, the EN-DCR was successful in 10 patients (55.55%). The mean follow-up was 12.7 months (6-22 months). The difference between the 2 groups was statistically significant (P < 0.05). CONCLUSIONS: Recurrent nasolacrimal duct obstruction after primary DCR is mainly due to reclosure of the nasolacrimal stoma and osteotomy site with granulation tissue. Adjunctive use of intraoperative MMC seems to be a safe adjuvant that could help in increasing the success rates of revision EN-DCR surgery.

Change in retinal vessel diameter and choroidal thickness in patients with severe COVID-19: Change In Retinal Parameters In Patients With Severe COVID-19.

PURPOSE: To compare the differences in retinal vascular structure and choroidal thickness between the active disease and post-recovery periods in COVID-19 patients and healthy controls. MATERIAL AND METHODS: This prospective, cross-sectional study included 30 eyes from 30 patients with severe COVID-19 and 30 eyes of 30 sex-matched healthy controls. Central macular thickness (CMT), subfoveal choroidal thickness (CT) and retinal vascular changes of patients were measured after positive polymerase chain reaction (PCR) (where the patient had COVID-19-related symptoms) and then three months after two negative PCRs. Laboratory parameters, including C-reactive protein and d-dimer levels, were also recorded. RESULTS: The mean age of the patients was 47.90 ± 9.06 years in patients group, 49.07 ± 8.41 years in control goups (p = 0.467). In terms of choroidal thicknesses subfoveal, nasal and temporal region were significantly higher in the active disease period than control group (p = 0.019, p = 0.036, p = 0.003, respectively). When the after recovery period was compared with the control group in terms of choroidal thickness, although the choroidal thickness was higher in all regions, this difference was not found statistically significant. There was no statistically significant difference in CMT between groups (p = 0.506).The mean venous and arterial wall thicknesses were significantly higher in the active period than after recovery (p = 0.023, p = 0.013, respectively) but there were no differences between after recovery and control groups in the pairwise comparison (p = 0.851, p = 0.715, respectively). CONCLUSION: In patients with severe COVID-19, there are changes in thickness of the choroid and retinal vessel walls. While vascular wall thickness increases due to inflammation, the absence of lumen changes may be associated with hemodynamic variables.

Bilateral acute depigmentation of the iris first misdiagnosed as acute iridocyclitis.

Acute depigmentation of the iris is a new condition characterized by pigment dispersion in the anterior chamber, depigmentation of the iris stroma, and pigment deposition in the anterior chamber angle. A 33-year-old woman using a topical corticosteroid every 2 h for the treatment of acute iridocyclitis was referred to our clinic to seek another opinion because her symptoms had not improved. An ocular evaluation of the patient revealed pigment precipitates on the corneal endothelium, pigment dispersion in the anterior chamber, symmetrical diffuse depigmentation, granularity of the iris stroma, and pigment deposition in the trabecular meshwork. These findings suggested a diagnosis of bilateral acute depigmentation of the iris (BADI) instead of iridocyclitis. Clinicians should be careful in the differential diagnosis of iris depigmentation from iridocyclitis to avoid the unnecessary use of high-dose topical corticosteroids.

Bilateral Tonic Pupils in the Absence of Pupillary Cholinergic Supersensitivity.

We report a 24-year-old woman with a presenting complaint of bilateral dilated pupils. The pupils were found to be dilated in bright and dim room lighting with minimal light reaction, showed an accommodation response, but did not demonstrate cholinergic supersensitivity. Neurological examination and neuro-imaging of the patient were normal. Syphilis serology was negative. This case emphasises that tonic pupil may be found in the absence of pupillary cholinergic supersensitivity.

Common embryological links to the optic pit and anterior segment structures.

PURPOSE: To analyze the anterior segment structures in patients with an optic disc pit to evaluate the common embryological links to the optic disc pit and anterior segment structures in these patients. METHODS: Ten patients with a unilateral optic disc pit detected during routine examination of the posterior pole and 15 healthy subjects as a control group underwent anterior segment analysis with Pentacam (Oculus, Inc., Wetzlar, Germany). Anterior segment parameters were compared between the eyes with an optic disc pit and fellow eyes of the patients and between the right and the left eyes of the healthy subjects. RESULTS: The anterior segment parameters of the eyes with an optic disc pit and fellow eyes of the patients were as follows, respectively: radius of the anterior corneal surface (7.68 +/- 0.28 and 7.71 +/- 0.28 mm), radius of the posterior corneal surface (6.36 +/- 0.28 and 6.43 +/- 0.28 mm), corneal thickness (532.40 +/- 31.32 and 530.20 +/- 28.51 micorm), corneal volume (58.86 +/- 3.72 and 58.42 +/- 3.37 mm), anterior chamber depth (3.28 +/- 0.80 and 2.98 +/- 0.39 mm), anterior chamber volume (178.00 +/- 36.48 and 168.30 +/- 38.14 mm), anterior chamber angle (39.30 +/- 6.00 and 36.52 +/- 5.66 degrees), and pupil diameter (3.15 +/- 0.64 and 2.96 +/- 0.47 mm). Only the back radius of corneal curvature was found to be statistically significantly lower in eyes with an optic disc pit (p = 0.025). The interocular comparison of anterior segment parameters in the healthy subjects showed no statistically significant difference (p > 0.05). CONCLUSIONS: The study demonstrates that those eyes with an optic disc pit have smaller back radius of corneal curvature compared with fellow eyes. Possibly, the embryological factors in the development of optic disc pit influence the development of cornea.

Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS).

BACKGROUND: Sleep-related disorders are among the important risk factors for neurovascular diseases. Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, excessive daytime sleepiness, and insomnia. Our aim was to investigate the presence of glaucoma in patients with OSAS and to reveal vascular pathology related to the pathogenesis of glaucoma in those patients. PATIENTS AND METHODS: The study included 31 patients with OSAS and 25 control subjects. Orbital Doppler ultrasonography was used to determine the resistivity index (RI) in the ophthalmic artery and central retinal artery. All patients and controls underwent perimetric examination. RESULTS: The prevalence of glaucoma in the group of patients with OSAS was 12.9% (4/31); all of these 4 patients with glaucoma were in the "severe" OSAS group. No statistically significant difference was found between ophthalmic artery resistivity index (OARI), central retinal artery resistivity index (CRARI), and intraocular pressure (IOP) between patients and controls (p > 0.05). There was a positive correlation between OARI and mean defect (MD), CRARI and MD, and CRARI and loss variance (LV) values (p < 0.05). There was also a positive correlation between IOP and the apnea-hypopnea index (AHI) (p = 0.001). CONCLUSIONS: In patients with OSAS, a high prevalence was found and it is interesting to note that all of the four glaucoma patients were in the severe OSAS group. The positive correlation observed between IOP and AHI suggests that increased IOP values may reflect the severity of OSAS. The positive correlation between OARI and MD and also between CRARI and MD as well as LV suggests that visual field defects may be due to optic nerve perfusion defects and these field defects also increase as the RI increases.

Effect of topical cyclopentolate on post-operative pain after pterygium surgery.

OBJECTIVES: The aim was to evaluate the effectiveness of topical cyclopentolate following pterygium surgery for post-operative ocular pain. METHODS: All participants had nasal pterygium and underwent pterygium excision and conjunctival autografting with fibrin glue. Participants were randomised into two groups. Participants in group 1 received one per cent cyclopentolate eye drops and artificial tears upon completing surgery and were prescribed self-administered drops three times daily for three days, while participants in group 2 received a control (artificial tears) in a manner identical to group 1. Data were gathered regarding post-operative pain intensity experienced during each of the three days. Pain was graded from zero to 10 according to a visual analogue scale, in which zero signified no pain and 10 signified severe, unbearable pain. RESULTS: This study analysed data regarding 38 participants in group 1 and 40 participants in group 2. Results were defined as median with interquartile range (IQR); median of the pain scores at days one, two and three were as follows, respectively: 4 (IQR 2), 2.5 (IQR 1) and 2 (IQR 1.25) for group 1 and 5 (IQR 1), 3 (IQR 1.75) and 3 (IQR 1) for group 2. Pain scores were significantly lower for group 1 compared with group 2 at days one, two and three (p < 0.05). CONCLUSIONS: Topical cyclopentolate seems to be effective and well tolerated following pterygium surgery for post-operative ocular pain.

Ocular penetration of topically applied 1% tigecycline in a rabbit model.

AIM: To evaluate ocular penetration of topically applied 1% tigecycline. METHODS: Forty-two New Zealand White rabbits were divided into 3 groups. A 50 µL drop of 1% tigecycline was administered in group 1. In groups 2 and 3, the drop was administered every 15min for 60min (keratitis protocol). Aqueous humor samples in groups 1 and 2 were collected under general anesthesia at 15, 30, 45, 60, 120, and 180min after the last drop. All animals in group 3 were euthanatized. Cornea, vitreous and blood samples were collected 60 and 120min after the last drop. Tigecycline concentrations were measured using high performance liquid chromatography-mass spectrometry (LC-MS/MS). RESULTS: The peak aqueous humor tigecycline concentration [mean 0.73±0.14 mg/L (SD) and 2.41±0.14 mg/L, respectively] occurred 45min after topical drug application in groups 1 and 2. Group 3 mean values in the cornea, and vitreous, were 3.27±0.50 µg/g, and 0.17±0.10 mg/L at 60min and 3.17±0.77 µg/g and 0.20±0.07 mg/L at 120min, respectively. Tigecycline serum concentrations were negligible. CONCLUSION: Tigecycline levels in the aqueous humor in groups 1 and 2, and in the cornea in group 3 exceeded the minimum inhibitory concentrations of most gram-positive organisms that cause bacterial keratitis and endophthalmitis.

Ozurdex completely located inside a crystallized lens - Results of 14 months.

PURPOSE: To report the therapeutic efficacy and results of an accidentally injected intralenticular sustained-release dexamethasone implant (Ozurdex) in a patient with macular edema secondary to central retinal vein occlusion at 14 months after injection. OBSERVATIONS: We present a 70-year-old female patient with central retinal vein occlusion who underwent an Ozurdex injection. Patient discontinued from the treatment period during the 14-month and there was no ophthalmologic examination of the patient. Detailed ophthalmological examination was performed. Ozurdex localization was determined by Pentacam rotating Scheimpflug System. The implant was accidentally injected into the crystalline lens. It did not cause a totally lens opacification but did result only in a posterior subcapsular cataract. The macular edema did not resolve, and the patient underwent phacoemulsification surgery. CONCLUSIONS AND IMPORTANCE: Ozurdex that totally located inside the crystallize lens may not have the therapeutic effects.

Daptomycin versus Vancomycin in an Enterococcus faecalis Endophthalmitis Rabbit Model.

PURPOSE: To compare bactericidal activities of daptomycin (DAP) and vancomycin (VAN) in an experimental rabbit model of Enterococcus faecalis endophthalmitis. MATERIALS AND METHODS: The right vitreous cavities of 24 New Zealand rabbits were inoculated with 100 colony-forming units of E. faecalis; and after 24 h, rabbits were randomly divided into three groups. DAP group (n = 8, 0.2 mg/0.05 ml intravitreally), VAN group (n = 8, 1 mg/0.05 ml intravitreally) and balanced salt solution group (BSS, n = 8, 0.05 ml intravitreally). Clinical examination scores were recorded, and vitreous aspirates were obtained for microbiological analysis on days 0, 1, 2, 3 and 4. Rabbits were sacrificed, and the eyes were enucleated for histopathological assessment. RESULTS: There was no difference between the DAP, VAN and BSS groups in terms of the clinical grading of endophthalmitis 24 h after the inoculation. The bacterial counts were similar between the VAN and DAP groups except on day 1, where it was significantly lower than those in the VAN group (p = 0.003). On day 4, 62% of the eyes treated with DAP, and 50% of the eyes treated with VAN were sterilized. All of the eyes from the BSS group showed increasing bacterial growth from day 0 to day 4. There was no difference between the DAP and VAN groups in terms of the histopathological and clinical examination scores, while they were significantly lower than those in the BSS group. CONCLUSIONS: This study demonstrates evidence of the effectiveness of DAP for the treatment of experimental E. faecalis endophthalmitis.