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Focus on hot spots: Will new crown virus infection and new crown vaccine injection cause fundus complications?

Posting time:2022-10-06 01:12:51

Focus on hot spots: Will new crown virus infection and new crown vaccine injection cause fundus complications?

Editor's note: The 22nd European Society of Retina Experts Conference (Euretina 2022) was grandly opened in Hamburg, Germany. The conference attracted thousands of ophthalmologists to share academic frontiers, discuss hotspots in the field, and promote together. skill improved. Despite the impact of the epidemic, the enthusiasm of ophthalmology colleagues to pursue knowledge cannot be stopped. The foreign correspondents of "International Ophthalmology News" will deliver the latest conference information in a timely manner, and have an academic feast with you. The chairman of the conference, Professor Alistair Laidlaw, said in his opening speech that he was very grateful to everyone for participating in the 22nd Retina Conference. This is currently the largest restaurant conference in the world. The first Euretina conference was also held in Hamburg, Germany in 2001. Compared to the first conference with only 230 participants, the Euretina conference has made great progress. Professor Laidlaw pointed out that there are many reasons to attend the Euretina conference. For example, attending the conference has the opportunity to take a break from the busy work and think about whether the work you do is intentional and meaningful. As everyone wishes, Euretina meetings are where you can discuss issues with colleagues, find guidelines for your work, and help yourself do a better job. Many clinicians participated in the convening and organization of the meeting, and made great efforts. I am very grateful to these doctors for their hard work! I wish all those who follow the Euretina conference can benefit a lot from this conference and have a wonderful academic journey! Since the outbreak of the new crown virus, the complications caused by the new crown virus infection and the side effects of vaccination have become the focus of global attention. At the 22nd European Association of Retina Specialists (EURETINA 2022), ophthalmologists from various countries shared the latest cases and research results of the new crown and vaccine-related ocular complications. Acute macular neuroretinopathy after 2019-nCoV infection Wojciech Dyda and his team from Poland reported a related case of acute macular neuroretinopathy in a patient with 2019-nCoV infection. A 35-year-old woman reported an abnormal central visual field of the left eye without other symptoms. The symptoms appeared 2 weeks ago, and she did not seek medical attention for 3 days with fever. Routine COVID-19 PCR test was performed 5 days after the first visit, and the result was positive. received compulsory treatment. The results of eye examination showed that there was no abnormality in the anterior segment, the macular area was slightly discolored, and there was a choroidal pigment nevus. The results of the fundus imaging examination are shown in the figure below. The patient is advised to stop oral contraceptives and take aspirin 75 mg daily for one year. 0.1% Nepafenac (Nepafenac) eye drops three times a day, one drop each time for 3 months. After 22 months of follow-up, it was found that the paracentral scotoma in the visual field was basically improved, and the OCT examination results showed that the structure tended to be normal. There are two types of acute macular neuroretinopathy, one is typical acute macular neuroretinopathy/acute extramacular retinopathy (AMOR), which mainly affects the outer retina, and the other is paracentral acute middle macular degeneration (PAMM), Mainly affects the inner retina. Coronary plexus capillary ischemia can be manifested in both cases, and it is more common in young women in their 30s. The associated pathogenic factors include fever, oral contraceptives, hypotension, hypercoagulable state, and caffeine. Acute macular neuroretinopathy after vaccination with the new crown vaccine SUZAN ABOUZEID and his team from the United Kingdom reported a case of acute macular neuroretinopathy complicated by retinal vein stasis and hemorrhage of the fibrous layer of the henle after vaccination with the new crown vaccine. A 36-year-old woman woke up with decreased vision in her right eye and reported a central opaque circular scotoma in her right eye. She received a booster of the new crown vaccine two weeks ago, and received two previous injections of Pfizer's new crown vaccine. is taking oral contraceptives. Ultra-wide-field fundus examination revealed dilated and tortuous fundus veins, retinal hemorrhage, and swelling of the optic disc in the right eye. The left eye was unremarkable. OCT examination showed hyperreflection in the middle retina of the right eye. After 10 days, the fundus hemorrhage disappeared, the swelling of the optic disc was reduced, the dilation of the venous blood vessels was reduced, and the hyperreflective area of ​​the fundus disappeared. The examination results showed normal platelet count and normal coagulation function, excluding vaccine-induced thrombocytopenia; anticardiolipin antibodies were negative, and serum homocysteine ​​was normal. The final diagnosis was retinal vein stasis with Heinz fibrous layer hemorrhage and acute macular neuroretinopathy. Vaccine-related fundus lesions require further research on the temporal correlation with vaccines, to determine whether the vaccines have pathogenic effects, and to summarize and analyze them after being reported in the vaccine reporting system to further study the possible ocular complications caused by vaccines. Could fundus vascular lesions be a manifestation of new coronavirus infection? Sonja P Cekic and his team from the University of Serbia speculated whether the new coronavirus infection can manifest as fundus vascular lesions. Coronavirus infection 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 that primarily affects the respiratory system and can impair the function of blood vessels anywhere in the body. SARS-CoV-2 can affect eye health on many levels, and previous studies have found that the virus can be isolated in tears, joints and even the retina. Many authors have reported direct or indirect symptoms of retinal circulation changes in patients with COVID-19, including retinal hemorrhages and cotton wool spots, retinal vein occlusion. Optic disc neuritis is a neurological manifestation of COVID-19 disease. On this basis, the researchers summarized and analyzed some cases of retinal vasculopathy and neuroneuropathy manifestations in patients diagnosed with SARS-CoV-2 infection. Five patients were referred to an ophthalmologist due to visual impairment during COVID-19 infection. The ophthalmological examinations accepted include: vision examination, anterior segment examination, posterior segment examination, fundus fluorescein angiography, OCT, visual field examination, and ocular ultrasonography. Blood tests include: CRP, d-dimer, fibrinogen, numbers and proportions of neutrophils and lymphocytes. Three female patients, aged 30, 32, and 34 years, were diagnosed with papillitis; two male patients, both aged 40 years, were diagnosed with central venous occlusion. All patients were COVID-19 PCR positive and had symptoms of COVID-19 infection. Five patients were otherwise healthy. Ocular symptoms and blurred vision in the second week of COVID infection. Blood laboratory tests were performed on the 1st, 3rd, and 5th days of the second week of infection, and it was found that the level of CRP was significantly increased, and the level of erythrocyte sedimentation rate, D-dimer, and fibrinogen were also significantly increased. Examination of visual evoked potentials in patients with papillitis revealed increased optic nerve latency and decreased optic nerve amplitude. In retinal occlusion and COVID-19 patients, all systemic factors contributing to retinal vein occlusion were excluded. Patients with CRVO were treated with systemic methylprednisone. One patient developed macular edema, and subsequent OCT examination found that the macular edema disappeared within 2 weeks after treatment. In patients with papillitis, MR of the intracranial and optic nerves demonstrated no demyelinating lesions. All three patients received intravenous methylprednisone followed by oral corticosteroids. Retinal hemorrhages, cotton wool spots, and tortuous vessels in patients with COVID-19 infection. Most of these patients did not complain of ocular symptoms. The reported patient presented with visual symptoms during the second week of infection, possibly related to hematological changes during COVID-19 infection. Optic neuritis may be associated with serum antibodies to myelin oligodendrocyte glycoprotein. More similar cases are expected in the future due to the COVID-19 pandemic. Prospective studies are needed to determine the relationship between viral antigens, severity of COVID-19 infection, and associated optic neuritis and venous occlusion. The fundus complications that may be caused by the new coronavirus infection and the ocular risk of the new crown vaccine injection have gradually become the focus of eye fundus experts. Physiological mechanisms and find appropriate intervention methods.

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