Ophthalmic Manifestations Research Articles

Ophthalmic Presentations and Manifestations of COVID-19: A Systematic Review of Global Observations.

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, 2021to 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.

Talc retinopathy as a result of long-term intravenous drug abuse

Narcotic substances have a pronounced toxic effect on the entire body and can lead to disability. Despite ongoing efforts to combat drug addiction, in today's society, many drugs are available for potential use. Their destructive action leads to numerous adverse ocular and systemic manifestations. The most frequently, the drug-users are people of working age, in whom visual impairment leads to restrictions on labor and social activities.
 The article considers a clinical case of talcum retinopathy, which developed as a result of long-term abuse of intravenous drugs; the ophthalmic manifestations and a possible treatment option are described.

Optic Neuritis as Manifestation of Local Viral Encephalitis (Clinical Observation)

In the practice of an ophthalmologist and neurologist, the identification of relationship between optic neuritis and inflammation of the brain tissue is accompanied by significant diagnostic difficulties. In this regard, the role of interdisciplinary consultations is valuable, as an ophthalmologist knows the methods of ophthalmological diagnostics, which allow for topical diagnosis of the brain damage level, but for a neurologist, these methods are inaccessible. A clinical case of herpetic optoencephalitis (descending optic neuritis against the background of local encephalitis) in a teenager with a favorable outcome after conservative treatment is considered in the given paper. Conclusion: It is important to remember that during the optoencephalitis formation, its ophthalmic manifestations can remain not only the manifestation of this focal neurological pathology for a long time, but also require the timely appointment of appropriate routes of administration, doses and duration of etiotropic drugs use, therefore, the utmost diagnostic alertness regarding viral encephalitis (opticoencephalitis) is important at the slightest suspicion of a descending origin of the identified eye tissues inflammation.

Ретинальные изменения после коронавирусной инфекции

The SARS-CoV-2 coronavirus infection pandemic has caused 667 million cases. COVID-19 is a severe acute respiratory infection caused by the SARS-CoV-2 coronavirus. The virus primarily affects the respiratory system and runs the gamut from respiratory infection, to acute respiratory distress syndrome. Various ophthalmologic manifestations in both the anterior and posterior segment of the eye are increasingly reported in the literature. Purpose. Present clinical cases of retinal changes after coronavirus infection. Material and methods. We present two clinical observations of patients with ophthalmic manifestations in the posterior segment of the eyes that developed after a coronavirus infection. All patients underwent ophthalmological examination including visometry, anterior segment biomicroscopy, and ophthalmoscopy with non-contact Volk 78D lens, optical coherence tomography (OCT) of macular area and angioregim OCT (DRI OCT Triton plus, Japan). Treatment and recommendations were individualized according to ophthalmological indications. Results. Stabilization of retinal changes after coronavirus infection. There was an increase in maximum corrected visual acuity (MCOZ), reduction of macular edema. Conclusion. It is necessary to pay attention to complaints of the visual organ in patients with coronavirus infection in the early stages of the disease and in the nearest months after recovery. Our clinical observations show the need for further study of pathogenesis, clinic and treatment methods of ophthalmologic complications associated with coronavirus infection. Keywords: coronavirus disease, postthrombotic retinopathy, macular neovascular membrane

Ophthalmic Manifestations in Fabry Disease: Updated Review.

Fabry disease (FD) is an X-linked lysosomal storage disorder, causing Gb-3 (globotriaosylceramide) buildup in cellular lysosomes throughout the body, in particular in blood vessel walls, neuronal cells, and smooth muscle. The gradual accumulation of this glycosphingolipid in numerous eye tissues causes conjunctival vascular abnormalities, corneal epithelial opacities (cornea verticillata), lens opacities, and retinal vascular abnormalities. Although a severe vision impairment is rare, these abnormalities are diagnostic indicators and prognostics for severity. Cornea verticillata is the most common ophthalmic feature in both hemizygous men and heterozygous females. Vessel tortuosity has been linked to a faster disease progression and may be useful in predicting systemic involvement. New technologies such as optical coherence tomography angiography (OCTA) are useful for monitoring retinal microvasculature alterations in FD patients. Along with OCTA, corneal topographic analysis, confocal microscopy, and electro-functional examinations, contributed to the recognition of ocular abnormalities and have been correlated with systemic involvement. We offer an update regarding FD ocular manifestations, focusing on findings derived from the most recent imaging modalities, to optimize the management of this pathology.

Ophthalmic manifestations in children with Down Syndrome in Bogotá, Colombia

BackgroundTo describe the ocular features of a cohort of children with Down Syndrome (DS) in Bogotá, Colombia.MethodsWe performed a cross-sectional study, evaluating 67 children with DS. A pediatric ophthalmologist performed a complete optometric and ophthalmological evaluation of each child, including visual acuity, ocular alignment, external eye examination, biomicroscopy, auto-refractometry, retinoscope in cycloplegia, and fundus examination. Results were reported as frequency distribution tables with percentages for categorical variables and means and standard deviation or median and interquartile ranges for continuous variables, according to their distribution. We used the Chi-square test or Fisher’s exact test for categorical variables and ANOVA or Kruskal–Wallis for continuous variables when indicated.ResultsA total of 134 eyes from 67 children were evaluated. Males represented 50.7%. The children’s age ranged from 8–16 years, with a mean of 12.3 (SD 2.30). The most frequent refractive diagnosis per eye was hyperopia (47%), followed by myopia (32.1%) and mixed astigmatism (18.7%). The most frequent ocular manifestations were oblique fissure (89.6%), followed by amblyopia (54.5%) and lens opacity (39.4%). Female sex was associated with strabismus (P = 0.009) and amblyopia (P = 0.048).ConclusionOur cohort had a high prevalence of disregarded ophthalmological manifestations. Some of these manifestations, such as amblyopia, can be irreversible and severely affect the neurodevelopment of DS children. Therefore, ophthalmologists and optometrists should be aware of the visual and ocular affection of children with DS to assess and provide appropriate management. This awareness could improve rehabilitation outcomes for these children.

Cross-sectional study to describe the severity, bio-chemical associations, and final outcomes of COVID-19-associated rhino-orbital-cerebral mucormycosis in a tertiary hospital of East India

The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio-chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality.This retrospective, hospital-based study included all in-patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer levels at presentation and outcome.There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty-two (89.4%) had pre-existing diabetes, and five (10.6%) had steroid-induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL-6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL-6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03).Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL-6 levels are best associated with survival.

Ophthalmic manifestations of monkeypox infection

After the global COVID-19 pandemic, there has been an alarming concern with the monkeypox (mpox) outbreak, which has affected more than 110 countries worldwide. Monkeypox virus is a doublestranded DNA virus of the genus Orthopox of the Poxviridae family, which causes this zoonotic disease. Recently, the mpox outbreak was declared by the World Health Organization (WHO) as a public health emergency of international concern (PHEIC). Monkeypox patients can present with ophthalmic manifestation and ophthalmologists have a role to play in managing this rare entity. Apart from causing systemic involvement such as skin lesions, respiratory infection and involvement of body fluids, Monkeypox related ophthalmic disease (MPXROD) causes varied ocular manifestations such as lid and adnexal involvement, periorbital and lid lesion, periorbital rash, conjunctivitis, blepharocounctivitis and keratitis. A detailed literature review shows few reports on MPXROD infections with limited overview on management strategies. The current review article is aimed to provide the ophthalmologist with an overview of the disease with a spotlight on ophthalmic features. We briefly discuss the morphology of the MPX, various modes of transmission, an infectious pathway of the virus, and the host immune response. A brief overview of the systemic manifestations and complications has also been elucidated. We especially highlight the detailed ophthalmic manifestations of mpox, their management, and prevention of vision threatening sequelae.

Monkeypox-Associated Manifestations and Complications Involving the Eye: A Systematic Review and Meta-Analysis of Previous and Current Outbreaks.

The purpose of this study was to pool the prevalence rate of monkeypox-associated eye manifestations and/or complications during the current and previous outbreaks. A systematic review and meta-analysis. On August 7, 2022, PubMed, Scopus, Web of Science, EMBASE, and Google Scholar were searched for relevant articles. We included all studies that reported the involvement of the eye (either as a manifestation or a complication) among patients with monkeypox. The primary outcome included pooling the effect size (ES) of reported manifestations and complications, and the secondary outcome included the conduct of a subgroup analysis based on the timing of the monkeypox outbreak (before vs. during 2022). Eleven studies reporting 3179 monkeypox-confirmed cases were included. Eye manifestations included conjunctivitis, corneal, conjunctival, and eyelid lesions, photophobia, and eye pain. Compared with previous monkeypox outbreaks, the current outbreak revealed much lower rates of ocular involvement in terms of conjunctivitis (ES=1%; 95% CI: 0%-1% vs. ES=17%; 95% CI: 11%-22%), corneal and conjunctival lesions (ES=1%; 95% CI: 0%-2% vs. ES=13%; 95% CI: 4%-22%), and eyelid lesions (ES=1%; 95% CI: 0%-4% vs. ES=13%; 95% CI: 5%-28%). Monkeypox-associated eye complications were reported only in the previous outbreaks which included keratitis (ES=4%; 95% CI: 3%-6%), corneal ulceration (ES=4%; 95% CI: 2%-5%), unilateral (ES=3%; 95% CI: 1%-4%) and bilateral blindness (ES=0%; 95% CI: 0%-2%), and impaired vision (ES=4%; 95% CI: 1%-8%). Ophthalmic manifestations and complications are common among monkeypox-confirmed cases. Although these data are mainly related to previous outbreaks, health care workers should familiarize themselves with these signs to provide better care for monkeypox patients.

Ophthalmic Manifestations Among Patients Surviving COVID-19.

To identify ocular findings related to SARS-CoV-2 infection in patients after the resolution of COVID-19 using complete ocular examinations and optical coherence tomography (OCT). In this cross-sectional study, conducted from May 30 to October 30, 2020, patients who recovered from various stages COVID-19 underwent eye examination and multimodal retinal imaging (Retinographies and Spectral-OCT). We included 50 patients, 29 (58%) males, median age of 46.5 [standard deviation 15.8]. Of these, 42% (21) had mild, 18% (9) had severe and 40% (20) had critical disease. The median time interquartile range (IQR) between symptom onset and ocular examination was 55 days [IQR 39-71]. Seven patients (14%) reported ophthalmic symptoms, transitory low visual acuity (6%) and retroocular pain (8%). On OCT, one patient without comorbidities had sectoral retinal pallor suggestive of acute retinal ischaemia and oedema of the retina's inner layers and atrophy. All findings progressively and spontaneously improved months after resolution of COVID-19. Patients with COVID-19 present findings compatible with the general population depending on age and comorbidities; nevertheless, acute retinal findings associated with the disease may be present, such as caused either by the direct effects of retinal SARS-CoV-2 infection, by indirect effects of the cytokine storm or by the pro-thrombotic state associated with COVID-19. Therefore, retinal involvement in patients with COVID-19 remains subject to considerable discussion and study.

A grading method for Kayser Fleischer ring images based on ResNet

The corneal K–F ring is the most common ophthalmic manifestation of WD patients. Early diagnosis and treatment have an important impact on the patient’s condition. K–F ring is one of the gold standards for the diagnosis of WD disease. Therefore, this paper mainly focused on the detection and grading of the K–F ring. The aim of this study is three-fold. Firstly, to create a meaningful database, the K–F ring images are collected which contains 1850 images with 399 different WD patients, and then this paper uses the chi-square test and Friedman test to analyze the statistical significance. Subsequently, the all collected images were graded and labeled with an appropriate treatment approach, as a result, these images could be used to detect the corneal through the YOLO. After the detection of corneal, image segmentation was realized in batches. Finally, in this paper, different deep convolutional neural networks (VGG, ResNet, and DenseNet) were used to realize the grading of the K–F ring images in the KFID. Experimental results reveal that the entire pre-trained models obtain excellent performance. The global accuracies achieved by the six models i.e., VGG-16, VGG-19, ResNet18, ResNet34, ResNet50, and DenseNet are 89.88%, 91.89%, 94.18%, 95.31%, 93.59%, and 94.58% respectively. ResNet34 displayed the highest recall, specificity, and F1-score of 95.23%, 96.99%, and 95.23%. DenseNet showed the best precision of 95.66%. As such, the findings are encouraging, demonstrating the effectiveness of ResNet in the automatic grading of the K–F ring. Moreover, it provides effective help for the clinical diagnosis of HLD.

Ophthalmic Manifestations of Multisystem Inflammatory Syndrome in Children

Abstract Objective The aims of this study were to determine the prevalence and clinical features of ophthalmic involvement in multisystem inflammatory syndrome in children (MIS-C) and to evaluate its association with other organ system involvement and the severity of the disease. Methods The demographic data and information on the ophthalmologic and other systemic organ manifestations, laboratory findings, treatment modalities, and clinical outcomes of 97 patients with MIS-C were retrospectively obtained from their hospital records. Sixty-two patients with MIS-C who were examined by ophthalmologists were included in the study. Statistical analysis was performed using R version 3.6.0, and a p-value < 0.05 was accepted as statistically significant. Results The patients' median age was 82 months (range, 11–204 months). Of the patients, 62.9% were male. The most common systemic involvements were mucocutaneous (83.9%) and cardiovascular (82.3%). Kawasaki disease was clinically observed in 71% of the patients (incomplete form, 53.2%). Ophthalmic involvement was observed in 39 patients (62.9%). Thirty-two patients (51.6%) had conjunctival hyperemia; 29 (48.4%) lid edema; 7 follicular conjunctivitis; 3 uveitis; 2 subconjunctival hemorrhage; and 1 episcleritis. The patients with ophthalmic involvement were 6.4 times (95% confidence interval [CI], 1.49–27.48; p = 0.013) more likely to exhibit cardiac involvement and 3.53 times (95% CI, 1.35–9.63; p = 0.012) more likely to have severe disease. Conclusion Conjunctival hyperemia, lid edema, and follicular conjunctivitis were observed in at least half of the patients with MIS-C, and those with ophthalmic involvement had a higher risk of cardiac involvement or severe disease.

Emerging Pathogenic Viral Infections of the Eye.

Global health security threats and the public health impact resulting from emerging infectious diseases including the ongoing COVID-19 pandemic and recent Ebola virus disease outbreaks continuously emphasize the need for a comprehensive approach to preparedness, management of disease outbreaks, and health sequelae associated with emergent pathogens. A spectrum of associated ophthalmic manifestations, along with the potential persistence of emerging viral pathogens in ocular tissues, highlight the importance of an ophthalmic approach to contributing to efforts in the response to public health emergencies from disease outbreaks. This article summarizes the ophthalmic and systemic findings, epidemiology, and therapeutics for emerging viral pathogens identified by the World Health Organization as high-priority pathogens with epidemic potential.

Ophthalmic manifestations in patients recovered from COVID-19 in Mexico

Introduction and objectivesAlthough the ophthalmic manifestations appear to be associated with the coronavirus disease 2019 (COVID-19), there is not enough evidence. Hence, the aim of this study was to determine the various types and frequency of ophthalmic manifestations in patients recovered from SARS-CoV-2 infection in Mexico. Material and methodsThis retrospective, observational and descriptive study included all patients recovered from SARS-CoV-2 infection attending the tertiary level hospital of Mexican Social Security Institute (IMSS) from June 2020 to June 2022. During the hospital admission of patients, the demographic data such age, name, gender was recorded. Ophthalmologic examination was performed under torchlight by an ophthalmologist in the Department of Ophthalmology from IMSS. Data was compiled and statistically analyzed using Fisher’s exact test and Spearman correlation. ResultsA total of 3081 SARS-CoV-2-positive patients were recorded, of which 318 (10.32%) met the inclusion criteria. Of them, 21 (6.60%) had ophthalmic manifestations and the female-to-male ratio was 1.6:1. The mean age (±SD) was 47.95±15.27 years and the median (interquartile range) time from the diagnosis of COVID-19, as defined by positive SARS-CoV-2 RT-PCR testing, to detection of the ophthalmic manifestation was 31 (142) days. The most common ocular manifestation was orbital mucormycosis (23.80%). Interestingly, the presence of ophthalmic manifestations was not associated with severe COVID-19 (p=0.665). ConclusionsThe ophthalmic manifestations are infrequent in patients recovered from severe COVID-19. Nevertheless, further large sample studies are needed to confirm these findings.

Peripheral ulcerative keratitis in a patient with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) can have various ophthalmic manifestations, of which a rare but serious association is peripheral ulcerative keratitis (PUK), which can progress to corneal melt and perforation. Adequate immuno-suppression and close follow-up are required in these patients to prevent ocular and systemic progression of disease. We report a case of PUK in SLE which progressed rapidly despite immuno-suppression and required surgical intervention.

Characteristics of a Three-Generation Family with Stickler Syndrome Type I Carrying Two Different COL2A1 Mutations

Stickler Syndrome is typically characterized by ophthalmic manifestations including vitreous degeneration and axial lengthening that predispose to retinal detachment. Systemic findings consist of micrognathia, cleft palate, sensorineural hearing loss, and joint abnormalities. COL2A1 mutations are the most common, however, there is a lack of genotype-phenotype correlations. Retrospective, single-center case series of a three-generation family. Clinical features, surgical requirements, systemic manifestations, and genetic evaluations were collected. Eight individuals clinically displayed Stickler Syndrome, seven of whom had genetic confirmation, and two different COL2A1 mutations (c.3641delC and c.3853G>T) were identified. Both mutations affect exon 51, but display distinct phenotypes. The c.3641delC frameshift mutation resulted in high myopia and associated vitreous and retinal findings. Individuals with the c.3853G>T missense mutation exhibited joint abnormalities, but mild ocular manifestations. One individual in the third generation was biallelic heterozygous for both COL2A1 mutations and showed ocular and joint findings in addition to autism and severe developmental delay. These COL2A1 mutations exhibited distinct eye vs. joint manifestations. The molecular basis for these phenotypic differences remains unknown and demonstrates the need for deep phenotyping in patients with Stickler syndrome to correlate COL2A1 gene function and expression with ocular and systemic findings.

Офтальмологические проявления на заднем отрезке глаза после коронавирусной инфекции

An outbreak of SARS-CoV-2 coronavirus infection has caused 667 million cases. COVID-19 is a severe acute respiratory infection caused by the SARS-CoV-2 coronavirus. The virus primarily affects the respiratory system and causes from mild signs, respiratory infection, to a severe course, acute respiratory distress syndrome. Multiple ophthalmologic manifestations in both the anterior and posterior segment of the eye are increasingly reported in the literature. Purpose. To present clinical cases of postocular ophthalmic manifestations on the ocular fundus. Material and methods. Four clinical cases of ophthalmologic manifestations in the posterior segment of the eyes that developed after a coronavirus infection were presented. All patients underwent ophthalmological examination including visometry, anterior segment biomicroscopy, as well as ophthalmoscopy with non-contact Volk 78D lens, optical coherence tomography (OCT) of macular area and OCT in angioregim (DRI OCT Triton plus, Japan). Treatment and recommendations were individualized according to ophthalmological indications. Results. Stabilization of postocular ophthalmic manifestations in the posterior segment of the eye. There was an increase in maximum corrected visual acuity (MCOZ), reduction of macular edema, adherence of neuroepithelial detachment (ONE). Conclusion. It is necessary to pay attention to the complaints of the visual organ in patients with COVID-19 in the early stages of the disease and in the nearest months after recovery. Our clinical observations show the necessity of further study of pathogenesis, clinic and treatment methods of ocular complications associated with COVID-19. Keywords: coronavirus disease, postthrombotic retinopathy, macular neovascular membrane, central serous chorioretinopathy

Ophthalmic immune-related adverse events associated with immune checkpoint inhibitors.

To investigate the incidence of immune-related adverse events (irAEs) of immune checkpoint inhibitor (ICI) therapy and to report the clinical features, management, and outcomes of ophthalmic irAEs. We retrospectively reviewed the medical records of patients who received ICI therapy from January 2016 to September 2022 at Peking Union Medical College Hospital and analyzed the incidence of systemic and ophthalmic adverse effects of this therapy. Of 962 patients, 248 (25.8%) experienced irAEs. The first-year incidences of total irAEs and ophthalmic irAEs were 23.5% and 1.1%. The most common ICI received by the patients was pembrolizumab (373; 38.8%). Nearly half of the patients (477; 49.6%) had lung cancer. Combination therapy was associated with an increased incidence of irAEs without statistical significance. Patients with lung cancer presented with an increased incidence of total irAEs (p = 0.003) and ophthalmic irAEs (p = 0.032). Eleven patients had ophthalmic manifestations, including ophthalmoplegia (6/11), conjunctivitis (3/11), reactive cutaneous capillary endothelial proliferation (RCCEP) (1/11), and orbital inflammation (1/11). Eight patients had concomitant extra-ophthalmic irAEs. Furthermore, ICIs were discontinued in nine patients, and most ophthalmic manifestations were well controlled with topical and systemic steroids. Ten patients were treated with intravenous or oral steroids. However, cancer progression occurred in five out of eleven patients after the interruption of ICIs. IrAEs are correlated with ICI regimens and underlying neoplasia. In our Chinese cohort, patients have a higher risk of ophthalmoplegia than uveitis. Early recognition and multidisciplinary consultation are crucial for optimal treatment of ophthalmic irAEs.

Histopathology and SARS-CoV-2 Cellular Localization in Eye Tissues of COVID-19 Autopsies

Ophthalmic manifestations and tissue tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in association with coronavirus disease 2019 (COVID-19), but the pathology and cellular localization of SARS-CoV-2 are not well characterized. The objective of this study was to evaluate macroscopic and microscopic changes and investigate cellular localization of SARS-CoV-2 across ocular tissues at autopsy. Ocular tissues were obtained from 25 patients with COVID-19 at autopsy. SARS-CoV-2 nucleocapsid gene RNA was previously quantified by droplet digital PCR from one eye. For this current study, contralateral eyes from 21 patients were fixed in formalin and subject to histopathologic examination. From the other four patients, sections of the droplet digital PCR-positive eyes were evaluated by in situ hybridization to determine the cellular localization of SARS-CoV-2 spike gene RNA. Histopathologic abnormalities, including cytoid bodies, vascular changes, and retinal edema, with minimal or no inflammation in ocular tissues were observed in all 21 cases evaluated. In situ hybridization localized SARS-CoV-2 RNA to neuronal cells of the retinal inner and outer layers, ganglion cells, corneal epithelia, scleral fibroblasts, and oligodendrocytes of the optic nerve. In conclusion, within ocular tissues, a range of common histopathologic alterations were identified, and SARS-CoV-2 RNA was localized to multiple cell types. Further studies will be required to determine whether the alterations observed were caused by SARS-CoV-2 infection, the host immune response, and/or preexisting comorbidities.

Case Report: Asymmetric Changes of Ophthalmic Findings in Bilateral Solar Eclipse Maculopathy.

A more profound understanding of the relationship between ophthalmic findings and eye dominance is needed to guide the timely and proper treatment of binocular photic maculopathy or other macular degeneration. A patient with binocular solar maculopathy presented with asymmetric ophthalmic manifestations and changes over 14 months of observation. Early recognition of solar maculopathy can be vital for early diagnosis and better prognosis. A 21-year-old male was reported to have blurred vision after staring directly at an annular solar eclipse several times for a few seconds on June 21, 2020. His Snellen best-corrected visual acuity (BCVA) declined to 20/50 in both eyes. He was right-eye dominant according to the hole-in-the-card test. The fundoscopy found a yellow spot in the center of both maculae. Spectral domain optical coherence tomography (SD-OCT) images revealed a full thickness hyperreflectivity extending from the inner retinal layers to the retinal pigment epithelium (RPE) along with a localized disruption of the ellipsoid portion of the inner segments and RPE in both eyes. The medical history and clinical manifestations described above supported the diagnosis of solar maculopathy. SD-OCT images during follow-up indicated a diminishing disruption of the ellipsoid portion of the inner segments and RPE without treatment. Interestingly, the non-dominant left eye made a better anatomical recovery. Finally, the Snellen BCVA remained 20/20 in both eyes after 14 months. Binocular solar maculopathy can present asymmetrically and recover asymmetrically as well. The dominant eye suffered more obvious damage and poorer anatomical recovery than the non-dominant eye.