Case Report: Associated Ocular Adverse Reactions With Inactivated COVID-19 Vaccine in China

The vaccine is still the best clinical measure for effective prevention and control of coronavirus disease 2019 (COVID-19). The vaccine-associated ocular adverse reactions should be noted in detail among the medical community. We reported twelve eyes of 9 patients presented at the Department of Ophthalmology, Qilu Hospital of Shandong University from March to August 2021 with ocular complaints following COVID-19 vaccination. The main inclusion criterion was the development of ocular symptoms within 14 days after receiving a dose of an inactivated COVID-19 vaccine. The mean (SD) age was 44.7 ± 16.5 years (range, 19–78 years), among which seven (77.8%) cases were women. The mean time of ocular adverse events was 7.1 days (range, 1–14 days) after receiving the inactivated COVID-19 vaccine. One patient was diagnosed with choroiditis, 1 with uveitis, 4 with keratitis, 1 with scleritis, 1 with acute retinal necrosis, and 1 with iridocyclitis. Although the causal relationship between vaccines and ocular adverse events cannot be established from this case series report, physicians should pay attention to the ocular adverse reactions following the COVID-19 vaccine administration.

Association of Allergic Symptoms in the First 2 Years of Life With Sleep Outcomes Among Chinese Toddlers

Background: Previous studies have linked allergic symptoms to sleep in children, but the associations might be different when considering different types of allergic symptoms or sleep outcomes. Moreover, the combined effects of multiple allergic symptoms remain unclear in early life. This study aimed to investigate the associations between multiple allergic symptoms and sleep outcomes in early life.Methods: We included 673 toddlers aged 2 years from a birth cohort in Guangzhou, China. We identified allergic symptoms (skin, eyes and nose, gastrointestinal tract, mouth and lips, and wheeze) within 2 years via standard questionnaires. Sleep outcomes including sleep duration and quality over the past month were assessed based on the Chinese version of the Brief Infant Sleep Questionnaire. Associations between allergic symptoms and sleep outcomes were examined using multivariable linear regression and logistic regression.Results: Compared to children without allergic symptoms, children with allergic nasal and ocular symptoms had higher odds of frequent nighttime awakenings (OR = 1.41; 95% CI: 1.03, 1.93) and irregular sleep (OR = 1.45, 95% CI: 1.05, 2.00); children with allergic gastrointestinal symptoms slept 0.28 h less during nighttime (95% CI: −0.48, −0.07) and 0.25 h less per day (95% CI: −0.43, −0.08), and had 59% higher odds of irregular sleep (95% CI: 1.24, 2.04). We also found significant association of multiple allergic symptoms with shortened nighttime sleep duration and increased irregular sleep. Whereas, allergic skin, mouth and lips, and wheeze symptoms were not significantly associated with sleep outcomes.Conclusion: Allergic symptoms within 2 years of age were adversely associated with sleep outcomes, which highlight the importance of early screening of allergic symptoms in toddlers in order to improve their sleep outcomes.

Guided meditation for vision acuity training on adolescent myopia: study protocol for an open-label, prospective, multicenter, randomized controlled trial

Background Currently, the population with myopia climbs steadily, and is developing toward younger age, posing a great concern to the health of adolescents. Myopia in severe cases can cause irreversible consequences such as glaucoma, blindness, and other complications. At present, the solutions for myopia are glasses, medication, and surgery. This study aims to investigate the role of a physiotherapy category based on guided meditation for vision acuity training on adolescent myopia. Methods This is a prospective, randomized, multicenter clinical trial. One thousand one hundred forty primary and secondary school students aged 8–18 years old from 27 schools will be recruited and randomly divided into an experimental and a control group at a ratio of 2:1 in two phases, with a training period of 30 days in each phase and a follow-up period of 3 months. No interventions will be conducted during the follow-up period, nor will other interventions employed. Inclusion criteria will meet the diagnostic criteria for simple myopia and −6.00D ≤ spherical lenses ≤ −0.50D and cylindrical lenses ≤1.50D. The primary observation index will be to compare the statistical differences in distant visual acuity between the two groups; the secondary observation indexes will be ocular symptoms (mainly including eye fatigue, dryness, pain, double vision, neck pain, thought disorders, and lags in response), diopter, and astigmatism. Discussion The purpose of this two-phase trial is to compare the clinical effectiveness of focused vision-guided meditation with Chinese eye exercises that are also non-pharmacological, non-invasive interventions for myopia, and to maximize the benefit to the subjects. The results will indicate whether the training based on focused vision-guided meditation has the ability to improve distant visual acuity, relieve ocular symptoms, and ameliorate diopter. In addition, this trial will provide clinical efficacy of the training, which is expected to provide meaningful data for vision rehabilitation. At the same time, the vision acuity training method, which is permeated with the concept of Traditional Chinese Medicine (TCM) rehabilitation and health maintenance, will be applied to achieve the goal of preventing or alleviating myopic development and reducing myopia rate. Trial registration Chinese Clinical Trial Registry ChiCTR2000038642. Registered on 26 September 2020

Cavernous Sinus Dural Arteriovenous Fistula in a Patient with Thyroid-Associated Ophthalmopathy: Complete Resolution after Medical Treatment

Thyroid-associated ophthalmopathy (TAO) is a well-known and frequent epiphenomenon of a hyperthyroid autoimmune disease that can present with proptosis, strabismus, and diplopia. Ophthalmopathy can occur in the absence of overt Graves’ disease, even in euthyroid patients. Cavernous sinus dural fistulas (CS-DAVF) are abnormal communications between the cavernous sinus (CS) and dural branches from internal carotid or external carotid arteries. They can often present with ocular symptoms that can mimic a thyroid-associated ophthalmopathy. CS-DAVF are usually successfully treated with an endovascular embolization that can be pursued both through a transvenous or transarterial approach. TAO and CS-DAVF can coexist especially when the ocular symptoms are unilateral. In those cases, an endovascular embolization is usually curative, but sometimes the procedure can fail. Our hypothesis is that some cases of CS-DAVF may be of secondary nature (i.e., caused by compression of the venous outlet by the hypertrophic ocular muscles); therefore, treating the ocular disease with medical therapy may solve the vascular problem as well. We present a case of a CS-DAVF in a patient with TAO successfully treated with sole medical therapy after the failure of a first-line endovascular treatment.

Detection of SARS-CoV-2-RNA in post-mortem samples of human eyes

Purpose To detect SARS-CoV-2 RNA in post-mortem human eyes. Ocular symptoms are common in patients with COVID-19. In some cases, they can occur before the onset of respiratory and other symptoms. Accordingly, SARS-CoV-2 RNA has been detected in conjunctival samples and tear film of patients suffering from COVID-19. However, the detection and clinical relevance of intravitreal SARS-CoV-2 RNA still remain unclear due to so far contradictory reports in the literature. Methods In our study 20 patients with confirmed diagnosis of COVID-19 were evaluated post-mortem to assess the conjunctival and intraocular presence of SARS-CoV-2 RNA using sterile pulmonary and conjunctival swabs as well as intravitreal biopsies (IVB) via needle puncture. SARS-CoV-2 PCR and whole genome sequencing from the samples of the deceased patients were performed. Medical history and comorbidities of all subjects were recorded and analyzed for correlations with viral data. Results SARS-CoV-2 RNA was detected in 10 conjunctival (50%) and 6 vitreal (30%) samples. SARS-CoV-2 whole genome sequencing showed the distribution of cases largely reflecting the frequency of circulating lineages in the Munich area at the time of examination with no preponderance of specific variants. Especially there was no association between the presence of SARS-CoV-2 RNA in IVBs and infection with the variant of concern (VOC) alpha. Viral load in bronchial samples correlated positively with load in conjunctiva but not the vitreous. Conclusion SARS-CoV-2 RNA can be detected post mortem in conjunctival tissues and IVBs. This is relevant to the planning of ophthalmologic surgical procedures in COVID-19 patients, such as pars plana vitrectomy or corneal transplantation. Furthermore, not only during surgery but also in an outpatient setting it is important to emphasize the need for personal protection in order to avoid infection and spreading of SARS-CoV-2. Prospective studies are needed, especially to determine the clinical relevance of conjunctival and intravitreal SARS-CoV-2 detection concerning intraocular affection in active COVID-19 state and in post-COVID syndrome.

Analysis of the Association between Galectin-3 Concentration in Tears and the Severity of Dry Eye Disease: A Case-Control Study

This study aimed to investigate the relationship between the severity of dry eye disease (DED) and galectin-3 concentration (gal-3) and its cleavage (gal-3C) in tear fluid. Twenty-eight DED patients and 14 controls were recruited at Keio University Hospital. The lissamine green conjunctival staining (LG) score, fluorescein corneal staining (FL) score, tear film break-up time (TBUT), Schirmer’s test, and ocular symptoms questionnaire score (dry eye questionnaire score, DEQS) were evaluated. Furthermore, the correlation between these parameters and the concentrations of gal-3 in tears (ng/µg) and the detection rate of gal-3C (%) were analyzed. Gal-3 concentration in tears was positively correlated with the LG score (R = 0.60, p < 0.01), FL score (R = 0.49, p < 0.01), and DEQS (R = 0.45, p < 0.01), and negatively correlated with the TBUT score (R = −0.40, p < 0.01) and Schirmer’s I value (R = −0.36, p < 0.01). The detection rate of gal-3C in tears was significantly associated with the severity of DED, especially with the LG (p < 0.01) and FL (p < 0.01) scores. Therefore, the concentration of gal-3 and the detection rate of gal-3C in tears had a significant relationship with the severity of ocular surface barrier disruption.

White-Eyed Orbital Blowout Fracture: A Retrospective Study of 22 Patients

Background and Objectives The study reports on the clinical experience of repairing white-eyed orbital blow out fracture through a retrospective study of various incidences of white-eyed orbital blow out fracture that resulted in different treatment methods and outcomes.Subjects and Method A retrospective study was performed on 22 patients with white-eyed blowout fracture who underwent operation between March 2009 and June 2019 at our clinic. Patients were divided into 2 groups by age: 6 to 12 and 13 to 18. A review of medical records included demographic data, cause of injury, preoperative symptoms, trauma to operation time and surgical outcomes including improvement of postoperative ocular symptoms and complications.Results The study population included 20 males and 2 female patients ranging from 6 to 18 years (mean, 14.2 years) of age. Fifteen of 21 patients with diplopia or limitation of eyeball movement showed a complete improvement of symptoms after surgery and 6 (28.5%) had remaining symptoms. One patient had no ocular symptom, but had oculocardiac reflex including nausea and vomiting. Two cases were re-operated due to adhesion of graft material. There was one sinus infection related to the implant.Conclusion This study shows that early reconstruction and release of incarcerated muscle within 5 days after trauma for white-eyed blowout fracture gives successful result that does not accompany major complications. All of the 22 patients who were operated for white-eyed blowout fractures had successful results.

Review of the Literature on Existing Management of Dry Eye Disease

Dry eye disease (DED) is a multifactorial disease in which the tear film’s homeostasis is lost, along with other ocular symptoms such as tear film instability and high osmolarity, neurosensory abnormalities, and ocular surface inflammation and damage. DED is a condition of lacrimal apparatus which is responsible for tear production. The tear film is a mixture of mucin, aqueous (water and solutes like NacI, sugar, urea, proteins,), lipids secreted by goblet cells, lacrimal glands, and meibomian glands, respectively. It keeps the eye moist, provides oxygen to the cornea, and has antibacterial properties. The lipid layer prevents the evaporation of the aqueous. DED is categorized into (i)Aqueous-tear deficiency, characterized by a deficiency of lacrimal glands to secrete tears, (ii)Evaporative DED, associated with increased tear loss by evaporation because there is a deficiency of the meibomian glands. The mechanism of DED might be loss of tear through evaporation or insufficient aqueous production or a combination of the two. DED is a widespread eye problem, which is often left untreated. It causes irritation, itching, dryness, foreign body sensation, and discomfort; severe case causes conjunctival congestion, keratinization, erosion of the corneal epithelium, and plaque formation. If left Univision- threatening vision-threatening, leading to complications like corneal ulceration and perforation. Various clinical tests are used to diose DED, including tear breakup time, tear osmolarity, Schirmer test, Rose Bengal staining, and expression of inflammatory markers. There is no cure for DED at present. The following modalities are used for its treatment: use of punctual and canalicular plugs, artificial tear products like polyethylene glycol/propylene glycol with guar HP, consuming food rich in omega-three fatty acids, antioxidants zeaxanthin, and lutein, Use of anti-inflammatory drugs, mucolytics, secretagogues. Reducing or avoiding mild risk factors like prolonged reading, prolonged use of contact lenses, excessive screen time, etc. Treatment of causative disease. Appropriate management and establishing reasonable patient expectations are necessary to ensure patient satisfaction and adherence to the treatment.

High-frequency radio wave electrocautery in modified Hotz operations for epiblepharon correction

To report the experience and advantageous effects of high-frequency radio wave electrocautery in modified Hotz operations for epiblepharon, We reviewed the records of all pediatric patients who underwent a modified Hotz operation with the use of high-frequency radio wave electrocautery (Ellman Surgitron Dual Frequency RF S5; Ellman International, Inc, Hewlett, NY) for epiblepharon between March 2016 and September 2019 at Korea University Guro Hospital. We evaluated the success rate, complications, recurrence rate and degree of satisfaction of our technique. Information from the medical records was collected, including demographics, ocular symptoms, severity of keratopathy, operation time, success/recurrence rate, and complications. 133 patients (98.52%) showed good correction of epiblepharon without complications or unpleasant cosmetic problems during 3 months of median follow-up period. Two patients (1.48%) showed recurrent corneociliary touch, but the degree was very mild and re-operation was not performed. One patient showed mild ectropion on his left lower eyelid, but the patient recovered well without operation. For complications, suture abscess and granulation were the most common, 3 cases in each, but all of those were temporary and resolved with conservative management. The approach with electrocautery for epiblepharon allows precise and fast incision of the lower eyelid, little bleeding, and minimal scarring. Surgical outcomes associated with the modified Hotz operation with electrocautery were consistent with previous studies.