Acute macular neuroretinopathy as a manifestation of coronavirus disease 2019: A case report.
TL;DR: In this article, the authors raise clinicians' awareness of the possibility of coincident acute macular neuroretinopathy (AMN) and COVID-19 as a potential cause of retinal vascular damage and ischemia.
Abstract: The current findings is important in raising clinicians' awareness of the possibility of coincident acute macular neuroretinopathy (AMN) and COVID-19 as a potential cause of retinal vascular damage and ischemia.
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TL;DR: The current report is a rare case of paracentral acute middle maculopathy (PAMM) in a previously healthy man following COVID‐19 vaccination.
Abstract: The current report is a rare case of paracentral acute middle maculopathy (PAMM) in a previously healthy man following COVID‐19 vaccination.
6 citations
TL;DR: COVID-19 is often characterized as a respiratory illness due to its much common involvement of the respiratory tract and an interesting correlation between AMN and Adenovirusbased CO VID-19 vaccines has been lately observed.
4 citations
TL;DR: A systematic review of 31 articles published between January 1, 2021 to January 13, 2022 explored the presenting ocular symptoms of COVID-19, diagnosis, duration of ophthalmic complications, as well as pre-existing comorbidities as discussed by the authors .
Abstract: As the presentations and complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to surface, the ocular manifestations have emerged as an area of interest. Research and reports conveyed the presence of several ophthalmic conditions observed in Coronavirus disease 2019 (COVID-19) patients. These publications documented a range of presentations varying from asymptomatic to serious impairments. The aim of this study is to characterize the ophthalmic pathologies and their frequencies observed due to COVID-19 in patients across different regions of the world. The goal is that the paper assists primary care physicians and healthcare providers. A systematic review of 31 articles published between January 1, 2021 to January 13, 2022, explored the presenting ocular symptoms of COVID-19, diagnosis, duration of ophthalmic complications, as well as pre-existing comorbidities. A total of 816 patients, 427 (52.3%) males and 389 (47.7%) females, from various regions of the world were investigated. Studies focusing on patients with a history of ocular pathologies, non-COVID-19 infections, complications associated with the COVID-19 vaccine, and pediatric patients were excluded from this study. Ocular complications were most commonly reported one to two weeks following the initial COVID-19 diagnosis. Analysis suggests that the “red” eye is the most prevalent presenting ophthalmologic symptom, followed by temporary vision loss. Conjunctivitis was also the most common clinical diagnosis reported, followed by neuro-retinal affection in the form of cotton wool spots (n=127 and n=9, respectively). This study summarizes ocular manifestations in COVID-19 patients and serves to help healthcare providers recognize common symptoms and their severity. This may lead to early diagnosis, treatment, and intervention of these manifestations.
TL;DR: In this article , the authors reviewed the demographic and clinical profile of patients developing acute macular neuroretinopathy (AMN) or paracentral acute middle maculopathy (PAMM) after receiving coronavirus disease-2019 vaccination or infection.
Abstract: Purpose: To review the demographic and clinical profile of patients developing acute macular neuroretinopathy (AMN) or paracentral acute middle maculopathy (PAMM) after receiving coronavirus disease-2019 (COVID-19) vaccination or infection. Methods: In this review article, the published literature was searched to determine cases developing either AMN or PAMM after COVID-19 vaccinations or infections. Data, including demographic profile, presenting features, symptoms, diagnosis, and clinical outcomes, were extracted from the selected publications. These parameters were compared between the two groups, i.e., patients developing AMN/PAMM either after vaccination or infection. Results: After the literature review, 57 patients developing either AMN (n = 40), PAMM (n = 14), or both (n = 3) after COVID-19 infection (n = 29) or vaccination (n = 28) were included (mean age: 34.9 ± 14.4 years; n = 38; 66.7% females). In 24.6% patients, the diagnosis of COVID-19 infection was preceded by the development of ocular disease. There were no significant differences in the age or gender between the patients developing AMN or PAMM after vaccination or infection (p > 0.13). Among the vaccination group, the highest number of patients developing AMN/PAMM were after the Oxford-AstraZeneca (n = 12; 42.9%). Patients with vaccination had a significantly early onset of AMN/PAMM compared to those with infection (11.5 ± 17.6 days versus 37.8 ± 43.6 days; p = 0.001). Conclusions: Both AMN and PAMM are reported to be associated with COVID-19 infections and in persons receiving vaccination against COVID-19. While COVID-19 infections and vaccinations may have a contributory role, other risk factors such as oral contraceptive pills may also play a role in the development of the disease.
TL;DR: In this article , three patient cases with bilateral AMN are described, which occurred in direct temporal relationship to a recent SARS-CoV-2 infection, and three Patientenfälle with einer beidseitigen AMN geschildert, die in einem direkten zeitlichen Zusammenhang with einem kürzlich zurückliegenden SARS CoV-1-2-Infektion auftraten.
Abstract: Zusammenfassung Die akute makuläre Neuroretinopathie (AMN) stellt eine seltene Krankheitsentität dar. Sie wird vor allem bei jungen Frauen mit zurückliegender grippeähnlicher Infektion oder mehrjähriger Einnahme oraler Kontrazeptiva beobachtet. Die Patienten beschreiben typischerweise eine subjektive Sehverschlechterung und mono- oder bilaterale, parazentral gelegene, relative Skotome. In manchen Fällen können sich in der funduskopischen ophthalmologischen Untersuchung dezente, scharf begrenzte, flache Läsionen in rötlich-brauner oder orangefarbener Färbung im Makulabereich zeigen. Die Diagnosestellung erfolgt meist mittels einer Nahinfrarot-Fundusaufnahme, in der sich hyporeflektive Areale darstellen, und der SD-OCT-Bildgebung, in der sich Veränderungen in den äußeren Netzhautschichten manifestieren. Nachfolgend werden 3 Patientenfälle mit einer beidseitigen AMN geschildert, die in einem direkten zeitlichen Zusammenhang mit einer kürzlich zurückliegenden SARS-CoV-2-Infektion auftraten. Abstract Acute macular neuroretinopathy (AMN) is a rare disease entity. It is mainly observed in young women with a history of influenza-like infection or who have been taking oral contraceptives for several years. Patients typically describe subjective visual deterioration and mono- or bilateral paracentral relative scotomas. In some cases, funduscopic ophthalmic examination may reveal subtle sharply demarcated flat lesions of reddish-brown or orange colour in the macular region. Diagnosis is usually made by near-infrared fundus imaging which shows hyporeflective areas, and SD-OCT imaging which manifests changes in the outer retinal layers. In the following, three patient cases with bilateral AMN are described which occurred in direct temporal relationship to a recent SARS-CoV-2 infection.
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TL;DR: It is suggested that ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus.
Abstract: Purpose Conjunctival signs and symptoms are observed in a subset of patients with COVID-19, and SARS-CoV-2 has been detected in tears, raising concerns regarding the eye both as a portal of entry and carrier of the virus. The purpose of this study was to determine whether ocular surface cells possess the key factors required for cellular susceptibility to SARS-CoV-2 entry/infection. Methods We analyzed human post-mortem eyes as well as surgical specimens for the expression of ACE2 (the receptor for SARS-CoV-2) and TMPRSS2, a cell surface-associated protease that facilitates viral entry following binding of the viral spike protein to ACE2. Results Across all eye specimens, immunohistochemical analysis revealed expression of ACE2 in the conjunctiva, limbus, and cornea, with especially prominent staining in the superficial conjunctival and corneal epithelial surface. Surgical conjunctival specimens also showed expression of ACE2 in the conjunctival epithelium, especially prominent in the superficial epithelium, as well as weak or focal expression in the substantia propria. All eye and conjunctival specimens also expressed TMPRSS2. Finally, Western blot analysis of protein lysates from human corneal epithelium obtained during refractive surgery confirmed expression of ACE2 and TMPRSS2. Conclusions Together, these results suggest that ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus. This highlights the importance of safety practices including face masks and ocular contact precautions in preventing the spread of COVID-19 disease.
248 citations
TL;DR: Advances in multimodal imaging have enabled better characterization of this retinal disorder and have led to newly proposed diagnostic criteria, which together provide insights into pathogenesis and guide areas of future investigation.
185 citations
TL;DR: COVID-19 has been reported in association with acute limb ischaemia, stroke and the so called “paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection” and PAMM and AMN have similar underlying pathophysiology.
Abstract: This report cases of two patients who presented with a new paracentral scotoma following SARS-CoV-2 infection. Patient 1 is a 37-year-old Caucasian female in week 14 of an uncomplicated pregnancy presented with a 1-day history of abrupt onset, faintly colourful, left eye paracentral scotoma. This was 35 days following the onset of a febrile illness with cough and anosmia. SARS-CoV-2 nasopharyngeal swab was not performed during the infection, but subsequently positive serology (IgG) has been confirmed. Past medical history included acephalgic visual migraine aura and right toxoplasma chorioretinitis. Examination showed normal visual acuity, no uveitis and fundoscopy was normal in the left eye. OCT changes correlated with the location of the scotoma. A focal area of hyper-reflective change in the inner and outer plexiform layers with inner nuclear layer volume loss was seen consistent with paracentral acute middle maculopathy (PAMM). Bloods were normal, including ESR, CRP, lipids, glucose, ANA and anti-phospholipid antibodies. An electrocardiogram and carotid Doppler ultrasound were normal. Patient 2 is a 32-year-old Caucasian male presented with a 4-day history of abrupt onset, faintly colourful, right eye paracentral scotoma. This was 16 days following the onset of nasopharyngeal swab confirmed COVID-19. Past medical history included acephalgic visual migraine aura. Examination showed normal visual acuity, no uveitis and fundoscopy was normal. Changes on infrared reflectance (white arrow) and OCT correlated with the location of the scotomaA focal area of faint outer plexiform layer hyper-reflective change and disruption of the interdigitation zone were seen consistent with acute macular neuroretinopathy. These patients developed PAMM and AMN soon after confirmed SARS-CoV-2 infection and possibly represent postinfectious complications.
123 citations
TL;DR: A 53-year-old man presented with acute loss of vision, negative scotoma and dyschromatopsia in his left eye and SARSCov-2 was confirmed by chest computed tomography-scan and RT-PCR in this patient.
Abstract: A 53-year-old man presented with acute loss of vision, negative scotoma and dyschromatopsia in his left eye. He reported contact with people with severe respiratory syndrome - coronavirus-2 (SARS-C...
75 citations
TL;DR: In this paper, a case of bilateral acute-onset scotoma following SARS-CoV-2 infection in a 19-year-old girl attributed to the presence of paracentral acute middle maculopathy (PAMM).
Abstract: We herein report a case of bilateral acute-onset scotoma following SARS-CoV-2 infection in a 19-year-old girl attributed to the presence of paracentral acute middle maculopathy (PAMM). She was tested positive for SARS-CoV-2 infection 2 weeks prior by reverse transcription PCR testing and
24 citations