Manifestaciones oftalmológicas del SARS-CoV-2: Revisión de la literatura / Ocular manifestations of SARS-CoV-2: Literature review

En esta revisión resumimos las principales publicaciones que informan sobre las potenciales manifestaciones oculares de la enfermedad por el nuevo coronavirus (COVID-19). La evidencia científica se basa en cartas al editor, casos clínicos aislados y series de casos, principalmente de corte transversal. Hasta la fecha, incluimos la conjuntivitis viral, una conjuntivitis inmunomediada y parálisis oculomotoras (POM). Se discute la posibilidad de retinopatía. La conjuntivitis viral puede aparecer aislada o asociada al cuadro sistémico, principalmente pulmonar, antes o después del inicio de los síntomas respiratorios. Puede ser tanto unilateral como bilateral, es típica la presencia de folículos, y presenta una duración variable entre 5 y 20 días. La conjuntivitis inmunomediada consiste en un enrojecimiento ocular acompañada de eritrodermia y febrícula. Aparece más frecuentemente en los niños y se ha asociado a un cuadro «Kawasaki-like» y síndrome del shock tóxico. Las POM pueden presentarse de forma aislada, o formando parte de un síndrome de Miller-Fisher, junto con ataxia e hiporreflexia. Los oftalmólogos presentamos un riesgo considerable de contraer la COVID-19 debido a un contacto estrecho con el paciente, exposición a las lágrimas y a las secreciones oculares y al uso de multitud de equipos y aparatos susceptibles de contaminarse

In this review, a summary is presented of the main reports regarding the potential ocular manifestations of the new coronavirus disease (COVID-19). Scientific evidence is based on letters to the editor, clinical cases and case series, cross-sectional, and a few longitudinal studies. To date, it includes viral conjunctivitis, immune conjunctivitis, and oculomotor palsies (OCP) due to the novel coronavirus. Retinopathy is discussed. A viral conjunctivitis outbreak can be isolated or associated with the systemic picture, mainly pulmonary, before or after the onset of respiratory symptoms. It can be both unilateral and bilateral, follicles are typical, and duration is variable between 5 and 21 days. Immune-mediated conjunctivitis consists of eye redness, together with erythroderma and fever. It appears more frequently in children, and has been associated with a «Kawasaki-like» disease and toxic shock syndrome. OCP can present on its own, or as part of Miller-Fisher syndrome, along with ataxia, and hyporeflexia. Ophthalmologists have a considerable risk of developing COVID-19 due to close contact with the patient, exposure to tears and eye secretions, and the use of various pieces of equipment and devices susceptible to contamination

Ocular manifestations of SARS-CoV-2: Literature review. / Manifestaciones oftalmológicas del SARS-CoV-2: Revisión de la literatura.

In this review, a summary is presented of the main reports regarding the potential ocular manifestations of the new coronavirus disease (COVID-19). Scientific evidence is based on letters to the editor, clinical cases and case series, cross-sectional, and a few longitudinal studies. To date, it includes viral conjunctivitis, immune conjunctivitis, and oculomotor palsies (OCP) due to the novel coronavirus. Retinopathy is discussed. A viral conjunctivitis outbreak can be isolated or associated with the systemic picture, mainly pulmonary, before or after the onset of respiratory symptoms. It can be both unilateral and bilateral, follicles are typical, and duration is variable between 5 and 21 days. Immune-mediated conjunctivitis consists of eye redness, together with erythroderma and fever. It appears more frequently in children, and has been associated with a «Kawasaki-like¼ disease and toxic shock syndrome. OCP can present on its own, or as part of Miller-Fisher syndrome, along with ataxia, and hyporeflexia. Ophthalmologists have a considerable risk of developing COVID-19 due to close contact with the patient, exposure to tears and eye secretions, and the use of various pieces of equipment and devices susceptible to contamination.

Queratopatía neurotrófica postherpética: etiopatogenia, clínica y terapias actuales / Post-herpes neurotrophic keratopathy: Aetiopathogenesis, clinical signs and current therapies

La queratopatía neurotrófica (QN) es una enfermedad corneal degenerativa causada por un daño en la inervación del nervio trigémino. Esta situación produce defectos epiteliales, ulceración y, eventualmente, perforación. Tanto la queratitis por herpes simple como por varicela zoster constituyen la principal causa de QN. Además, el pronóstico en este tipo de QN es pobre. Los hallazgos clínicos clásicos en la QN postherpética incluyen la rotura epitelial espontánea, defectos epiteliales ovalados y centrales de bordes suaves, queratolisis con adelgazamiento del estroma, cicatrización y neovascularización. Aunque se han descrito tratamientos médicos y quirúrgicos prometedores, actualmente no hay un tratamiento definitivo para restaurar la sensibilidad de la córnea. Por tanto, la QN sigue siendo un reto terapéutico. En esta revisión resumimos la patogenia, la clínica y el tratamiento actual de la QN postherpética. Se discute el papel del tratamiento antiviral y de las vacunas contra el virus de la varicela-zoster. Se describen nuevas terapias médicas y quirúrgicas, como los agentes regenerativos y la neurotización corneal

Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage of trigeminal innervation. This leads to epithelial defects, ulceration and, eventually, perforation. Both herpes simplex and varicella zoster keratitis are reported to be the main causes of NK. Furthermore, prognosis in this type of NK is poor. Classic clinical findings in post-herpes NK are spontaneous epithelial breakdown, round and central epithelial defects with smooth edges, stromal melting and thinning, scarring, and neovascularisation. Although several medical and surgical treatments have been reported, no therapies are currently available to definitely restore corneal sensitivity. Therefore, NK remains a challenging disease to treat. In this review a summary is presented of the pathogenesis, manifestations, and current management of post-herpes NK. The role of antiviral treatment and varicella-zoster vaccination is also discussed. A description is also presented on both medical and surgical novel therapies, such as regenerative drugs and corneal neurotization

Post-herpes neurotrophic keratopathy: Aetiopathogenesis, clinical signs and current therapies. / Queratopatía neurotrófica postherpética: etiopatogenia, clínica y terapias actuales.

Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage of trigeminal innervation. This leads to epithelial defects, ulceration and, eventually, perforation. Both herpes simplex and varicella zoster keratitis are reported to be the main causes of NK. Furthermore, prognosis in this type of NK is poor. Classic clinical findings in post-herpes NK are spontaneous epithelial breakdown, round and central epithelial defects with smooth edges, stromal melting and thinning, scarring, and neovascularisation. Although several medical and surgical treatments have been reported, no therapies are currently available to definitely restore corneal sensitivity. Therefore, NK remains a challenging disease to treat. In this review a summary is presented of the pathogenesis, manifestations, and current management of post-herpes NK. The role of antiviral treatment and varicella-zoster vaccination is also discussed. A description is also presented on both medical and surgical novel therapies, such as regenerative drugs and corneal neurotization.

Assessment of ocular redness measurements obtained with keratograph 5M and correlation with subjective grading scales.

OBJECTIVE: To examine correlations between ocular redness scores provided by the Keratograph 5M and those determined using two image-based grading scales. METHODS: Observational prospective cross-sectional study. Two hundred and twenty six eyes of two hundred and twenty six participants (175 patients using anti-glaucoma eye drops and 51 subjects untreated). All subjects were scored automatically using the keratograph 5M. These redness scores (RS) were then correlated with the gradings provided by the Efron and McMonnies/Chapman-Davies scale (MC-D) scales (two observers). RESULTS: Excellent reproducibility was observed for both the Efron (weighted K=0.897, 95% CI 0.823-0.904) and MC-D (weighted K=0.783, 95% CI 0.752-0.795) scales. Keratograph RS and the scores obtained with both Efron (Spearman's Rho=0.43, P<0.001) and MC-D (Spearman's Rho=0.48, P<0.001) scales were significantly correlated. RS for the bulbar and limbal - nasal and temporal quadrants also correlated moderately with the two subjective scales. Through Bland Altman analysis, poor agreement was detected between the objective and subjective methods: agreement values for the Efron scale or MC-D scale (matching scorers between observers) versus overall RS showed high biases (-15.58 and -22.05 respectively) and wide limits of agreement (LOA) (-46.169 to 15.005 and -52.534 to 8.19 respectively). Lowest bias was observed between temporal limbal RS and Observer 2 Efron score (-0.04). CONCLUSIONS: Although it emerged as a reliable objective method, the keratograph 5M overestimated the scores compared with the subjective grading scales when used to grade the degree of ocular redness. Therefore, they should not be interchangeable methods.

Pérdida visual debido a trombosis de senos venosos en neuro-Behçet / Visual impairment due to venous sinus thrombosis in neuro-Behçet's disease

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Neuropatía óptica retrobulbar unilateral como primera manifestación de la infección por el virus de la inmunodeficiencia humana / Unilateral retrobulbar optic neuropathy as the initial manifestation of human immunodeficiency virus infection

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Simulación de neuropatía óptica por drusas / Drusen simulating optic neuropathy

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Estudio de la relación entre miopía y personalidad / Study of the relationship between myopia and personality

Objetivo: Estudiar la correlación entre el error refractivo miópico y determinados rasgos de personalidad. Igualmente, se pretende determinar si existe correlación entre el grado de miopía y una mayor frecuencia de trastornos de la personalidad. Métodos: Estudio transversal observacional multicéntrico. La muestra la formaron 82 sujetos (26 hombres, 56 mujeres) mayores de 18 años con miopía (defecto esférico ≤ −0,5 D); 30 eran miopes magnos (<−6 D). Datos recogidos: edad y sexo, nivel de formación, resultado en el inventario de personalidad Neo PI-R, autorrefractometría, enfermedad miópica, tratamiento oftalmológico. Resultados: No se encontró correlación (rho de Spearman) estadísticamente significativa entre el defecto esférico y los rasgos de personalidad estudiados en el total de la muestra: neuroticismo (−0,057; p = 0,610), extraversión (−0,020; p = 0,857), apertura (−0,032; p = 0,774), amabilidad (−0,060; p = 0,592), responsabilidad (−0,034; p = 0,765). Al agruparlos por subgrupos de alta y baja significación (t-test), se halló una tendencia al aumento del defecto miópico con la extraversión, que resultó significativa (p = 0,002). Al comparar miopes magnos y el resto, se vio que existían diferencias significativas entre ambos grupos en cuanto a la enfermedad asociada (p < 0,001), el tratamiento recibido (p < 0,001) y el nivel de estudios ((p = 0,013), no así en las variables de personalidad: neuroticismo (p = 0,852), extraversión (p = 0,199), apertura (p = 0,560), amabilidad (p = 0,584), responsabilidad (p = 0,722). Conclusiones: Se encontró baja correlación entre miopía y personalidad. El grado de miopía no resultó diferente entre los grupos con diversos niveles de estudios. Los sujetos con enfermedad oftalmológica más grave asociada a la miopía presentaban puntuaciones más altas en neuroticismo, sin asociación significativa

OBJECTIVE: To study the correlation between the myopic refractive error and certain personality traits, and to determine whether there is a correlation between the degree of myopia and an increased frequency in personality disorders. METHODS: Cross-sectional observational multicenter study conducted on 82 subjects (26 men, 56 women) age over 18 years with myopia (spherical defect ≤ −0.5 D), with 30 subjects having high myopia (<−6 D). Data collected: age and gender, academic level, result in the Neo PI-R personality test, autorefractometry, myopic pathology, and ophthalmological treatment. RESULTS: Correlation (Spearman's) between the magnitude of the spherical defect and the 5 personality traits studied in the total sample was not statistically significant: neuroticism (−0.057; P=.610), extroversion (−0.020; P=.857), openness (−0.032; P=.774), kindness (−0.060; P=.592), and responsibility (−0.034;P=.765). By dividing them into subgroups of low and high significance (t-test), a significant (P=.002) upward trend of the myopic defect with increasing scores on extraversion was found. When comparing high myopic subjects to the non-high myopic ones, there were significant differences between the 2 groups in terms of the associated pathology (P=.001), received treatment (P=.001) and the level of studies (P=.013). There were no differences in the variables of personality: neuroticism (P=.852), extroversion (P=.199), openness (P=.560), kindness (P=.584), and responsibility (P=.722). CONCLUSIONS: A low correlation was found between myopia and personality. There was no difference in the degree of myopia between the groups with different education levels. Subjects with more severe ocular pathology associated with myopia had higher scores in neuroticism, without finding any significant association

Study of the relationship between myopia and personality.

OBJECTIVE: To study the correlation between the myopic refractive error and certain personality traits, and to determine whether there is a correlation between the degree of myopia and an increased frequency in personality disorders. METHODS: Cross-sectional observational multicenter study conducted on 82 subjects (26 men, 56 women) age over 18 years with myopia (spherical defect ≤ -0.5 D), with 30 subjects having high myopia (<-6 D). DATA COLLECTED: age and gender, academic level, result in the Neo PI-R personality test, autorefractometry, myopic pathology, and ophthalmological treatment. RESULTS: Correlation (Spearman's) between the magnitude of the spherical defect and the 5 personality traits studied in the total sample was not statistically significant: neuroticism (-0.057; P=.610), extroversion (-0.020; P=.857), openness (-0.032; P=.774), kindness (-0.060; P=.592), and responsibility (-0.034; P=.765). By dividing them into subgroups of low and high significance (t-test), a significant (P=.002) upward trend of the myopic defect with increasing scores on extraversion was found. When comparing high myopic subjects to the non-high myopic ones, there were significant differences between the 2 groups in terms of the associated pathology (P=.001), received treatment (P=.001) and the level of studies (P=.013). There were no differences in the variables of personality: neuroticism (P=.852), extroversion (P=.199), openness (P=.560), kindness (P=.584), and responsibility (P=.722). CONCLUSIONS: A low correlation was found between myopia and personality. There was no difference in the degree of myopia between the groups with different education levels. Subjects with more severe ocular pathology associated with myopia had higher scores in neuroticism, without finding any significant association.

Patología oftalmológica del Museo Olavide / Ophthalmic pathology of the Olavide Museum

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