{"id":1629,"date":"2021-06-18T07:42:27","date_gmt":"2021-06-18T05:42:27","guid":{"rendered":"https:\/\/magenta-gull-175109.hostingersite.com\/koronoios-matia-pithani-syndesi-tis-loimoxis-me-ofthalmikes-ekdiloseis\/"},"modified":"2021-06-18T07:42:27","modified_gmt":"2021-06-18T05:42:27","slug":"koronoios-matia-pithani-syndesi-tis-loimoxis-me-ofthalmikes-ekdiloseis","status":"publish","type":"post","link":"https:\/\/myretina.gr\/en\/koronoios-matia-pithani-syndesi-tis-loimoxis-me-ofthalmikes-ekdiloseis\/","title":{"rendered":"Coronavirus & Eyes - Possible link between infection and ocular manifestations"},"content":{"rendered":"

\u00abIntroduction\u00bb<\/strong><\/p>\n

The following article was published in the European Society of Cataract and Refractive Surgery (ESCRS) ophthalmological journal EURO TIMES.<\/p>\n

The article lists a number of studies conducted worldwide and currently underway, which investigate whether various ocular symptoms and ocular signs of the anterior and posterior segment of the eyes are associated with patients who have had or are experiencing infection with the novel COVID-19 coronavirus.<\/p>\n

Research evidence is also provided on the detection of the virus in the eyes and whether this is possible during the course of the disease.<\/p>\n

Finally, research evidence is presented on whether or not the eye is a gateway for the virus.<\/p>\n

Ever since Dr Li Wenliang (a Chinese ophthalmologist working at the Wuhan Central Hospital) warned his colleagues about a series of SARS-type pneumonia cases in late December 2019, ophthalmologists have been involved with COVID-19. What shook the global medical community, however, was the subsequent death of Dr Li from the virus, which he contracted from his asymptomatic glaucoma patient and dramatically demonstrated the need for universal precautions from COVID-19 during daily clinical practice.<\/p>\n

In the months that followed, the ocular manifestations of SARS-CoV-2 and COVID-19 infection were the subject of many studies. A recent study estimated the overall rate of ocular manifestations at 7%, with coronavirus confirmed to be present, in conjunctival smears with PCR testing in approximately 1% (Taiwan J Ophthalmol.2020 Jul-Sep? 10 (3): 153-166 .).<\/p>\n

However, other research suggests that ocular involvement may be more common depending on how it is defined. For example, a questionnaire of daily coronavirus symptoms given to patients attending hospitals in Strasbourg, Dijon, Nice, Brest and Colmar in France found that 36.7% of patients reported ocular symptoms, statistically associated with all major systemic manifestations, including flu-like illness, respiratory, neurological and digestive, said Dr Tristan Bourcier, professor of ophthalmology at the University Hospital of Strasbourg.<\/p>\n

As Dr Bourcier, who has been treating patients with acute COVID-19 disease with his colleagues at the University Hospital of Strasbourg since the pandemic broke out in France early last year, said, \u00abThe symptoms reported by the patients resembled mild conjunctivitis which confirms the possibility that the coronavirus is targeting the cells of the ocular surfaces creating a potential portal of entry.<\/p>\n

In addition, SARS-CoV-2 has also been detected in the tears of patients with COVID-19, who suffer from conjunctivitis during the illness.\u00bb.<\/p>\n

However, while COVID-19 infections of the anterior hemisphere could theoretically cause corneal graft rejection, uveitis or episodes of neuritis, the reality is different, Dr Bourcier says, \u00abmost of the patients with COVID-19 suffer from red eyes and eyelid swelling. In the majority of cases, there is no visual dysfunction or anatomical disturbances.\".<\/p>\n

This observation coincides with the clinical experience of Dr Jos\u00e9 G\u00fcell , Professor of Ophthalmology at the University Autonoma of Barcelona and Director of the Barcelona Society of Corneal and Refractive Surgery. However, while he has seen many cases of diffuse conjunctivitis in patients with COVID-19, and these cases are often referred to him, he has yet to see a conjunctival smear positive for the virus.<\/p>\n

Because these patients are also exposed to other eye-drying conditions, such as spending much more time looking at computer screens, mobile phones (smartphones) and staying indoors, he says, \u00abit's really hard to think that COVID is the cause.\u00bb Generally, these cases resemble mild viral conjunctivitis of the virus and respond well to low doses of topical corticosteroids. What concerns him much more is the risk of transmitting the virus to staff caring for the patients.<\/p>\n

CRYPTIC IOSIS<\/strong><\/p>\n

However, as Dr. Ashok Kumar, associate professor in the Department of Ophthalmology, Visual and Anatomical Sciences at Wayne State University School of Medicine, Detroit, said, the SARS-CoV-2 virus may be in the eye that cannot be detected by conjunctival smears. Research in his lab, in ocular tissues after autopsy of patients who died from COVID-19, found SARS-CoV-2 RNA in the posterior cornea (endothelial layer) of four patients and in the vitreous of one who was negative for the virus on conjunctival testing (Sawant OB et al. The Ocular Surface in press, online 8 November 2020).<\/p>\n

Dr Kumar noted that no live virus has yet been isolated from ocular tissues and suggested that conjunctival smears taken later in the course of the disease may be negative because the viral load declines rapidly. Indeed, in four patients whose nasopharyngeal swabs were examined in his laboratory who died of COVID-19, no viral RNA was detected. Virus was also detected in a small number of patients who tested positive two weeks after their death, who had died of another cause. It also highlighted the need to screen tissues intended for transplantation.<\/p>\n

THE ROLE OF INFLAMMATION<\/strong><\/p>\n

While both the conjunctiva and cornea express the ACE2 receptors and Furin protease required for SARS-CoV-2 to enter cells, it remains uncertain whether the ocular surface could be another gateway, Dr Kumar said. One of the unique aspects of his study is the presence of SARS-CoV-2 virus antigens (i.e.,Spike and Envelope proteins) in the corneal epithelium of donor eyes with COVID-19. This provides stronger evidence than viral RNA detection and suggests a possible susceptibility of ocular surface cells to SARS-CoV-2 infection. With colleagues at the University of California, he is conducting a study in mice expressing human ACE2 in the cornea to see if they can transmit systemic SARS-CoV-2 infection through the eye, creating a theoretical model for this route of transmission. They are also investigating the effect of the virus on cultured human corneal epithelial cells, particularly the generation of antiviral and inflammatory responses.<\/p>\n

He adds that these experiments are necessary to prove or disprove definitively whether the eye is a gateway for SARS-CoV-2.<\/p>\n

Dr Sezen Karakus and his colleagues at the Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA, are taking another approach to detect whether COVID-19 can manifest initially or exclusively as an eye infection. They are screening patients presenting with viral conjunctivitis to determine that several are associated with SARS-CoV-2. Following these patients may also shed light on whether such infections remain isolated in the eye or can develop into disease. As Dr. Karakus, who is an assistant professor of ophthalmology at Johns Hopkins University School of Medicine, said, \u00abIf conjunctivitis associated with SARS-CoV-2 is more common than we thought, patients presenting with conjunctivitis may need to be tested and isolated.\u00bb.<\/p>\n

While the involvement, if any, of SARS-CoV-2 in the anterior part of the eye appears mostly asymptomatic, however, infection in the posterior part of the eye may be a different matter, Dr Kumar said. In addition to his corneal research, he and his colleagues at UCLA are looking at how the virus affects retinal cells and the retina, using cell culture and animal models of SARS-CoV-2 infection, again looking for inflammation and antiviral responses.<\/p>\n

Although there is no evidence of visual impairment due to retinal involvement during COVID-19, long-term inflammation of the retinal blood vessels, as Dr Kumar says, \u00abcould lead to complications\u00bb.<\/p>\n

RETINAL IMAGING AS A DIAGNOSTIC TOOL<\/strong><\/p>\n

Dr Alessandro Invernizzi, Assistant Professor and Head of the Department of Uveitis and Ocular Infectious Diseases at the Ophthalmology Clinic - Department of Biomedical and Clinical Science \u00abLuigi Sacco\u00bb, University of Milan, said that the dilation of retinal blood vessels associated with COVID-19 can also play a role in assessing the severity and stage of the disease.<\/p>\n

From the research he conducted with other colleagues from the ophthalmology clinic, they found that both retinal veins and arteries were dilated in 54 patients with COVID-19 compared to 133 SARS-CoV-2 negative patients and the degree of vein dilatation was significantly positively correlated with disease severity and negatively correlated with the time of symptom onset. Moreover, as they state in their published article, \"If our data are confirmed, retinal vein diameter could represent a useful parameter for monitoring the inflammatory response and\/or endothelial damage during COVID-19 disease\" (Invernizzi et al. EClinicalMedicine published by The Lancet, 20 September 2020).<\/p>\n

The team's current research is focused on turning these preliminary findings into a clinical procedure that may be useful in predicting which patients will progress to severe disease, and Dr Invernizzi adds, \u00abJust by taking a single image of the fundus we can get a lot of information about the effect of COVID-19 on the vasculature. It's too early to say whether this will change the way we manage patients, but there is a lot of potential.\".<\/p>\n

Dr. Invernizzi's study also found a higher than expected incidence of other retinal abnormalities in COVID-19 patients compared to those who were SARS-CoV-2 negative, including hemorrhages at a rate of 9.25% and tortuous vessels at a rate of 12.9%. While these findings were not disease-specific and did not appear to compromise vision, they suggest a pathway for further research into the potential effects of SARS-CoV-2 on the retinal microvasculature. Further research is also required to determine whether the blood vessel dilation observed is directly due to the virus or is a product of a massive systemic inflammatory response.<\/p>\n

What Dr. Invernizzi suggests from his urine findings is that patients with COVID-19 should have a funduscopy and adds, \u00abMost of these patients do not complain of ocular symptoms. We can't really rely on patient complaints to say whether it's worth doing a fundus check. \".<\/p>","protected":false},"excerpt":{"rendered":"

\u00ab\u0395\u03b9\u03c3\u03b1\u03b3\u03c9\u03b3\u03ae\u00bb \u03a4\u03bf \u03ac\u03c1\u03b8\u03c1\u03bf \u03c0\u03bf\u03c5 \u03b1\u03ba\u03bf\u03bb\u03bf\u03c5\u03b8\u03b5\u03af, \u03b4\u03b7\u03bc\u03bf\u03c3\u03b9\u03b5\u03cd\u03c4\u03b7\u03ba\u03b5 \u03c3\u03c4\u03bf \u039f\u03c6\u03b8\u03b1\u03bb\u03bc\u03bf\u03bb\u03bf\u03b3\u03b9\u03ba\u03cc \u03c0\u03b5\u03c1\u03b9\u03bf\u03b4\u03b9\u03ba\u03cc EURO TIMES \u03c4\u03b7\u03c2 \u0395\u03c5\u03c1\u03c9\u03c0\u03b1\u03ca\u03ba\u03ae\u03c2 \u0395\u03c4\u03b1\u03b9\u03c1\u03b5\u03af\u03b1\u03c2 \u039a\u03b1\u03c4\u03b1\u03c1\u03c1\u03ac\u03ba\u03c4\u03b7 \u03ba\u03b1\u03b9 \u0394\u03b9\u03b1\u03b8\u03bb\u03b1\u03c3\u03c4\u03b9\u03ba\u03ae\u03c2 \u03a7\u03b5\u03b9\u03c1\u03bf\u03c5\u03c1\u03b3\u03b9\u03ba\u03ae\u03c2 (ESCRS). \u03a4\u03bf \u03ac\u03c1\u03b8\u03c1\u03bf \u03c0\u03b1\u03c1\u03b1\u03b8\u03ad\u03c4\u03b5\u03b9 \u03bc\u03b9\u03b1 \u03c3\u03b5\u03b9\u03c1\u03ac \u03b5\u03c1\u03b5\u03c5\u03bd\u03ce\u03bd \u03c0\u03bf\u03c5 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\u03bc\u03b1\u03c4\u03b9\u03ce\u03bd, \u03c3\u03c5\u03bd\u03b4\u03ad\u03bf\u03bd\u03c4\u03b1\u03b9 \u03bc\u03b5 \u03c4\u03bf\u03c5\u03c2 \u03b1\u03c3\u03b8\u03b5\u03bd\u03b5\u03af\u03c2 \u03c0\u03bf\u03c5 […]<\/p>\n","protected":false},"author":1,"featured_media":216,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-1629","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-5"],"yoast_head":"\u039a\u03bf\u03c1\u03c9\u03bd\u03bf\u03ca\u03cc\u03c2 & \u039c\u03ac\u03c4\u03b9\u03b1 - \u03a0\u03b9\u03b8\u03b1\u03bd\u03ae \u03c3\u03cd\u03bd\u03b4\u03b5\u03c3\u03b7 \u03c4\u03b7\u03c2 \u03bb\u03bf\u03af\u03bc\u03c9\u03be\u03b7\u03c2 \u03bc\u03b5 \u03bf\u03c6\u03b8\u03b1\u03bb\u03bc\u03b9\u03ba\u03ad\u03c2 \u03b5\u03ba\u03b4\u03b7\u03bb\u03ce\u03c3\u03b5\u03b9\u03c2 • myRetina \u03a0\u03c1\u03cc\u03c4\u03c5\u03c0\u03bf 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