Myopia Progression during the COVID-19 Era: A Systematic Review and Meta-analysis.

BACKGROUND: To evaluate myopia progression during the novel coronavirus disease 2019 (COVID-19) pandemic and its risk factors. METHODS: We searched PubMed, Scopus, and Web of Science to find literature until August 2022 related to COVID-19 pandemic and myopia progression. Outcomes of myopia progression included axial length (AL) and spherical equivalent (SE). Factors of screen time and outdoor activity time were analyzed. RESULTS: Thirty-three studies were included in this meta-analysis. Compared to the same period before the COVID-19 pandemic, myopia prevalence increased (OR = 1.11; 95% CI, 1.05-1.18). The outcomes of SE decreased -0.61 diopter (95% CI, -0.98 to -0.23), and AL increased 0.42 mm (95% CI, 0.13-0.7). Mean screen time was increased 6.25 hours/day (95% CI, 4.84-7.66), and outdoor activity time was decreased -1.52 hours/day (95% CI, -3.20 to -0.15). CONCLUSION: Establishing care policies is necessary to restrict behavioral changes and their consequences during the pandemic.

Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review.

PURPOSE: Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM). METHODS: The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants. RESULTS: A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases. CONCLUSIONS: Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.

Adverse Reactions from Topical Ophthalmic Anesthetic Abuse.

Purpose: To assess the adverse drug reactions (ADR) of tetracaine among patients referred to an eye emergency department in the southeast of Iran. Methods: In this case series study, we assessed 31 eyes of 24 patients who were referred due to adverse effects of ocular anesthetics during2017-2020. We collected the data, including age, sex, job, how the medicine was obtained, symptoms, examination results, and ADR. Results: Of 24 patients, 22 (91.7%) were male. The mean (standard deviation) age of the patients was 32.6 (1.9) years. Twenty-two patients obtained the medicines without a prescription and a general practitioner prescribed the medicine to two patients. In the first interview, the most common symptoms were: photophobia, reduced vision, ocular pain, and redness. The main signs of persistent epithelial defect, patchy or diffuse corneal stromal infiltration, ring infiltration, and Descemet's folds were noticed in the examinations. Finally, 51.6% (n =16) of the eyes had decreased vision, 45.2% (n =14) had corneal opacity, 16.1% (n = 5) had elevated intraocular pressure that needed long-term anti-glaucoma therapy, and 6.5% (n = 2) had corneal pannus. Corneal perforation and phthisis bulbi were the final results in one eye. Conclusion: ADR related to the use of ophthalmic topical anesthetics could cause sight-threatening severe morbidities. It seems that some general practitioners are not careful regarding the prescription of these kinds of medicine. Moreover, the over-the-counter availability of tetracaine eye drops should be managed.