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Sight-threatening intraocular infection in patients with COVID-19 in India
Authors:Sameera Nayak  Taraprasad Das  Deepika Parameswarappa  Savitri Sharma  Saumya Jakati  Subhadra Jalali  Raja Narayanan  Soumyava Basu  Mudit Tyagi  Vivek Pravin Dave  Rajeev Reddy Pappuru  Avinash Pathengay  Hrishikesh Kaza  Padmaja Kumari Rani  Shashwat Behera  Niroj Kumar Sahoo  Aditya Kapoor  Hitesh Agrawal  Komal Agarwal  Brijesh Takkar  Vishal Ramesh Raval
Institution:Vitreo-Retina and Uvea Services, L V Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Vijayawada, India;1.Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Telangana, India;2.Jhaveri Microbiology Centre and Saroja A Rao Immunology Laboratory, Telangana, India;3.Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India;4.Uvea Services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Vishakhapatnam, Andhra Pradesh, India
Abstract:Purpose:Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital.Methods:We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes.Results:The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5–72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7–63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi.Conclusion:Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.
Keywords:COVID-19  endogenous endophthalmitis  intraocular infection
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