The Impact of Severe COVID-19 on Corneal Endothelial Cells-Analysis of the In Vivo Noncontact Specular Microscopy.

PURPOSE: This study aimed to investigate the effects of severe COVID-19 infection on the corneal endothelium via in vivo specular microscopy. METHODS: This was an observational, prospective, and controlled study including 56 eyes of 56 severe COVID-19 patients, compared to after-recovery and 56 eyes of 56 age- and gender-matched healthy controls. RESULTS: Endothelial cell density was lower in the active disease period compared to healthy controls (p = .001) and decreased even more after recovery (p < .0001). After recovery, the average cell area and coefficient of variation were higher compared to the active disease period (p < .0001 and p = .008, respectively) and the healthy controls (for both, p < .0001), whereas hexagonality was lower (p < .0001). Central corneal thickness increased in the active disease period compared to after recovery (p < .0001) and healthy controls (p = .002). CONCLUSIONS: These results may be due to direct host-virus interaction or linked to immune dysregulation, subclinical corneal endotheliitis, or still yet a viral-mediated inflammation.

Assessment of the impact of N95 respirators or surgical masks use on the retinal microvasculature.

PURPOSE: To determine the possible impact of wearing N95 respirator or surgical masks on retinal vessel diameters and choroidal thickness in healthy healthcare workers. METHODS: Diameters of peripapillary retinal arteries and veins and choroidal thickness values at the foveal center and at 1000 µm distances from the foveal center in both nasal and temporal directions were measured before mask wearing using a spectral-domain optical coherence tomography. After four hours (h) of N95 or surgical mask wearing vessel diameter and choroidal thickness measurements were repeated. RESULTS: A total of 52 eyes from 52 participants (28 F [53.8%]; 24 M [46.2%]) were enrolled in this study. The mean age of patients was 34.58 ± 5.24 years (25-44 years). The diameters of all measured arteries [inferior temporal artery (p = 0.003), superior temporal artery (p < 0.001), inferior nasal artery (p = 0.003), and superior nasal artery (p = 0.004)] and veins,with the exception of superior nasal vein, (inferior temporal vein (p = 0.031), superior temporal vein (p = 0.027), inferior nasal vein (p < 0.001), and superior nasal vein (p = 0.063)] increased significantly after four hour use of N95 respirators and surgical maskswhen compared to baseline. There was also a significant diameter increase of the superior temporal (p < 0.001), inferior nasal veins (p < 0.001), and superior temporal artery (p = 0.037) for N95 respirators and surgical masks use, respectively. The differences in central subfoveal, temporal, and nasal choroidal thickness between baseline and after 4 h use of N95 respirators were statistically significant (From 366.73 ± 70.81 µm to 381.23 ± 69.29µm,p < 0.001 for the subfoveal; from 324.00 ± 64.13µm to 335.40 ± 61.35 µm, p = 0.007 for the temporal; from 297.40 ± 68.18 µm to 308.23 ± 74.51µm, p = 0.002 for the nasal thicknesses). Choroidal thickness values were also increased with surgical mask use. But only the increase in central subfoveal thickness was statistically significant (From 366.78 ± 71.00 µm to 372.58 ± 76.56 µm, p = 0.031 for the central subfoveal; from 297.42 ± 68.35 µmto 302.79 ± 73.05 µm, p = 0.068 for the nasal; from 324.01 ± 64.21µm to 330.33 ± 65.84, p = 0.117 for the temporal thicknesses). CONCLUSION: With four hours use of N95 respirators or surgical face masks, retinal vessel diameters and choroidal thicknesses showed an increase in comparison to baseline measurements. Hemodynamic changes seen secondary to hypercapnia due to prolonged use of N95 respirators or surgical masks may also be observed in the retinal and choroidal circulation. Furthermore, the use of face masks should be taken into account while assessing the retinal microvasculature.

Posterior ocular structural and vascular alterations in severe COVID-19 patients.

PURPOSE: This study aimed to evaluate posterior ocular structural and vascular changes in severe coronavirus disease 2019 (COVID-19) patients. METHODS: This was an observational, prospective, and controlled study including 106 eyes of 53 severe COVID-19 patients, compared to after recovery and 106 eyes of 53 age- and gender-matched healthy controls. All subjects were previously healthy adults and were assessed using spectral domain optical coherence tomography (SD-OCT) and ImageJ software. Subfoveal over a 1500-µm span and macular over a 6000-µm span cross-sectional areas of the vascular, stromal, and total choroid were measured. RESULTS: Of the 53 included patients, 28 (52.8%) were male, and 25 (47.2%) were female, with a mean age of 50.2 ± 7.4 years. In the active period of the disease, compared to after recovery and healthy controls, the outer plexiform layer thickness showed a significant increase (p = 0.004), and mean choroidal thickness was significantly higher (p < 0.0001); however, choroidal vascularity was significantly lower (p < 0.0001). The stromal area to vascular area (S/V) ratio of the choroid was significantly increased (p < 0.0001). All quadrants of the peripapillary retinal nerve fiber layer (RNFL) thicknesses were significantly increased (for all, p < 0.05). The reflectivity of OCT echo of the choroid and peripapillary RNFL was significantly higher (p = 0.023, p < 0.0001, respectively). CONCLUSION: This study detected significant posterior ocular structural and vascular alterations in patients with severe COVID-19 infections. These findings may be associated with direct host-virus interaction or linked to an autoimmune process, vasculopathy, or viral-mediated inflammation.

Corneal Parameters in Patients with Multiple Sclerosis: A Pilot Study.

OBJECTIVE: To evaluate the corneal topographic parameter values measured with the Pentacam Scheimpflug system in patients with multiple sclerosis (MS). METHODS: A total of 108 eyes of 62 MS patients were studied. In addition to a complete examination of anterior and posterior segments, all patients were scanned using the Pentacam Scheimpflug camera. The diagnosis of MS was made according to the McDonald criteria. All MS patients were clinically assessed using the Multiple Sclerosis Severity Score (MSSS). RESULTS: The mean age was 38.89 ± 10.18 years (36.16 - 41.30) for MS patients and 40.94 ± 9.44 years (38.49 - 43.11) for the controls (p = 0.26). Only central corneal thickness (CCT) and corneal volume (CV) values were significantly lower in MS patients (p < 0.001). The other corneal parameters were not significantly different between the study eyes and control eyes (p > 0.05 for all). Pachymetric measurements at the corneal apex were 525.69 ± 29.35 (518.29 - 533.67) µm for the study eyes versus 563.13 ± 23.70 (562.13 - 576.36) µm for the control eyes. CV were 59.22 ± 4.11(58.18 - 60.20) mm3 for the study eyes versus 62.78 ± 3.09 (62.38 - 64.00) mm3 for the control eyes. CONCLUSION: This is the first study that has reported lower CCT and CV measurements in MS patients than healthy subjects of a similar age. These results should be supported by further studies.

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.

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.

Comparison of the Thickness of the Fiber Layer of the Retinal Nerves in Spectral Domain Optical Coherence Tomography in Normal Eyes Older Than 40 Years.

PURPOSE: To compare measurements of the thickness of the retinal nerve fibre layer (RNFL) and assess the agreement between three different devices for spectral domain optical coherence tomography. MATERIAL AND METHODS: The RNFL thickness of both eyes of 23 normal subjects older than 40 years was measured using Canon HS100, Topcon Maestro, and NIDEK RS-3000 devices. Both eyes of each subject were scanned in random order. All scans were completed on the same day in the morning. The average and four quadrants (superior, inferior, nasal, and temporal) of RNFL thickness were measured. To determine the differences in RNFL thickness, analysis of variance for repeated measurements was performed. A Bland-Altman plot was plotted, and coefficients of determination were calculated. RESULTS: A total of 46 eyes of 23 subjects were enrolled in this study. The average RNFL thickness as determined by the three OCT devices was correlated (p < 0.001), but differed significantly between the three devices, as most were quadrant measurements. The mean average RNFL thickness was 98.5 ± 6.6 µm as measured by Canon HS100, 108.5 ± 8.8 µm as measured by Topcon Maestro, and 104.9 ± 9.0 µm as measured by NIDEK RS-3000. Topcon Maestro showed the highest average RNFL thickness value. Bland-Altman plots revealed considerable agreement among the three devices, except for the inferior quadrants between Topcon Maestro and NIDEK RS-3000 measurements. All three devices reveal considerable coefficients of determination values for mean RNFL thickness (0.917 - 0.127). CONCLUSION: Although the peripapillary RNFL thickness measurements taken with Canon HS100, Topcon Maestro, and NIDEK RS-3000 were in good agreement, they were not interchangeable in clinical practice, as the values differed significantly.

Susceptibility of severe COVID-19 patients to rhino-orbital mucormycosis fungal infection in different clinical manifestations.

PURPOSE: To present the different clinical manifestations of rhino-orbital mucormycosis (ROM) co-infection in severe COVID-19 patients. STUDY DESIGN: Prospective observational clinical study METHODS: Among 32,814 patients hospitalized with the diagnosis of COVID-19 between March 2020 and December 2020 in our center, eleven microbiologically confirmed ROM co-infection cases in severe COVID-19 patients were evaluated. RESULTS: There were nine men and two women with a mean age of 73.1 ± 7.7 years. Eight patients had uncontrolled type 2 diabetes with a mean diagnosis duration of 12.1 ± 4.4 years. All patients had COVID-19-associated acute respiratory distress syndrome and received corticosteroids. The mean time interval between COVID-19 diagnosis and ROM diagnosis was 14.4 ± 4.3 days. Seven patients (63.6%) had orbital apex syndrome, and four patients (36.4%) presented with orbital cellulitis. Endophthalmitis was detected in 54.5% of patients, and two of these patients developed retinoschisis. CT scan/MRI revealed sino-orbital involvement in all patients, and three of these had cerebral involvement at initial presentation. All patients received intravenous and retrobulbar liposomal amphotericin B and had undergone radical debridement of involved sinuses. Intravitreal liposomal amphotericin B injected in patients with endophthalmitis. Despite all measures, 63.6% of patients expired. CONCLUSIONS: Severe COVID-19 is associated with a significant incidence of ROM with higher mortality rates due to immune dysregulation and the widespread use of steroids. Physicians should be aware of the possibility of this infection in patients with COVID-19. An aggressive multidisciplinary approach can help to reduce mortality.

The Impacts of Face Mask Use on Standard Automated Perimetry Results in Glaucoma Patients.

PURPOSE: The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients. MATERIALS AND METHODS: All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients' face masks. RESULTS: A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients' reliability parameters improved, and inferior visual field artifacts disappeared. CONCLUSIONS: Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks' upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.

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.