COVID-19'un Oküler Bulguları

Öz

Aralık 2019’da bildirilen, SARS CoV-2 etkeninin sebep olduğu yeni tip Korona virüs hastalığı (COVID-19), etkenin
tutunduğu Anjiotensin Dönüştürücü Enzimin (ACE) tüm vücutta yaygın olarak bulunması sebebiyle, bir çok doku ve
organı etkileyebilmektedir. Pand emi süreci ilerledikçe oküler tutulumu gösteren yayınlar artmaktadır. Oküler tutulum
farklı klinik prezentasyonlarla olabilmektedir. Bu çalışmanın amacı COVID-19’un oküler tutulum ve komplikasyonları
patofizyolojisi ile gözden geçirmektir. Çalışmada Pubmed veri tabanı üzerinden Ocak 2020-Ekim 2020 döneminde
COVID-19’un göz bulgularını içeren makaleler taranarak bulgular değerlendirildi. Yapılan çalışmalarda hastalığın gözde
akut dönemde konjonktivit ve ön segment tutulumu ile presente olabilirken, sonraki süreçte ise mikrovasküler, trombotik,
iskemik ve inflamatuar lezyonlar ile arka segment tutulumu ön planda bildirilmektedir. Tüm bu bulgular COVID-19’un
uzun dönem etkileri olabilen ve uzun dönem takip gerektiren sistemik bir hastalık olduğunu düşündürmektedir.

Anahtar Kelimeler

• COVID-19
• SARS-CoV-2
• Göz
• Oküler bulgular

Ocular Findings of COVID-19

Öz

The new Corona Virus Disease (COVID-19) which is caused by the SARS– CoV-2 agent and first reported in December
2019, has the potential to damage many tissues and organs, since the angiotensin converting enzyme (ACE), which the
agent attaches, is expressed widely in the human body. As the pandemic period continues, the scientific publishes
pointing ocular involvement have been increased. Ocular involvement can be in different clinical presentations. The aim
of this study is to overview the ocular involvement, complications with pathophysiology of COVID-19. In this study a
search from Pubmed database is carried out,, the articles including ocular findings of COVID-19 between January 2020-
October 2020, are evaluated.. The studies report that the disease presents with conjunctivitis at the acute phase, since
microvascular, thrombotic, ischemic and inflammatory lesions are evident in the ongoing period. All these findings could
denote that COVID-19 is a systemic disease with ongoing effects and can request long term follow up.

Anahtar Kelimeler

• COVID-19
• SARS-CoV-2
• Eye
• Ocular findings

Kaynakça

1. Acharya, S., Diamond, M., Anwar, S., Glaser, A., Tyagi, P. (2020) Unique case of central retinal artery occlusion secondary to COVID-19 disease. ID Cases, 21:00867. 10.1016/j.idcr.2020.e00867.
2. Ackermann, M., Verleden, S., E., Kuehnel, M. (2020). Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med., 383(2):122–128. Agarwal, A., Invernizzi, A., Acquistapace, A. (2017). Analysis of retinochoroidal vasculature in human immunodeficiency virus infection using spectral-domain OCT angiography. Ophthalmol Retina, 1(6):545–554.
3. Bart, K., Chwalisz, M.D., Marc, J., Dinkin, M.D. (2020) Disease of the Year: COVID-19 and Its Neuro-ophthalmic Complications. J. Neuroophthalmol., doi: 10.1097/WNO.0000000000001046.
4. Bertoli, F., Veritti, D., Danese, C., Samassa, F., Sarao, V., Rassu, N.,…Lanzetta, P. (2020) Ocular Findings in COVID-19 Patients: A Review of Direct Manifestations and Indirect Effects on the Eye. J Ophthalmol., doi: 10.1155/2020/4827304.
5. Bogoch, I., Watts, A., Thomas-Bachli, A., Huber, C., Kraemer, M.U.G., Khan, K. (2020). Pneumonia of unknown etiology in Wuhan, China: potential for international spread via commercial air travel. J. Trav. Med, 27: DOI:10.1093/jtm/taaa008/570.
6. Casagrande, M., Fitzek, A., Püschel, K., Aleshcheva, G., Schultheiss, H., P., Berneking, L., Spitzer, M., S., Schultheiss, M. (2020). Detection of SARS-CoV-2 in human retinal biopsies of deceased COVID-19 patients. Ocul Immunol Inflamm, 28:721–5.
7. Chen, L., Deng, C., Chen, X., Zhang, X., Chen, B., Yu, H., Qin, Y. (2020). Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: a cross-sectional study. Acta Ophthalmol, 10.1111:14472.
8. Du Toit, A. (2020). Outbreak of a novel coronavirus. Nat. Rev. Microbiol, 18(123).

9. Gavriilaki, E., Brodsky, R., A. (2020). Severe COVID-19 infection and thrombotic microangiopathy: success does not come easily. British Journal of Haematology, 189(6):227-230.
10. Gutiérrez-Ortiz, C., Méndez- Guerrero A., Rodrigo-Rey, S., San Pedro- Murillo, E., Bermejo Guerrero, L., Gordo-Manas, R.,…Benito-Leon, J. (2020) Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology, 95(5):601-605.
11. Helms, J., Tacquard, C., Severac, F., Leonard-Lorant, I., Ohana, M., Delabranche, X.,…Meziani,F. (2020) High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intens Care Med., 46:1089-1098.
12. Insausti-García, A., Reche-Sainz, J.A., Ruiz-Arranz, C., López Vázquez, A., Ferro-Osuna, M. (2020) Papillophlebitis in a COVID-19 patient: Inflammation and hypercoagulable state. Eu. J. Ophthalmol., doi: 10.1177/1120672120947591 Invernizzi, A., Torre, A., Parrulli, S., Zicarelli, F., Schiuma, M., Colombo, V.,…Meroni, L. (2020). Retinal findings in patients with COVID-19: Results from the SERPICO-19 study. EClinicalMedicine, 27. https://doi.org/10.1016/j.eclinm.2020.100550.
13. Jee, Y. (2020). WHO International Health Regulations Emergency Committee for the COVID-19 outbreak. Epidemiol Health, 42:e2020013.
14. Jung, F., Krüger-Genge, A., Franke, R., Hufert, F., Küpper, J.H. (2020). COVID-19 and the endothelium. Clin. Hemorheol. Microcirc., 75(1):7-11.
15. Karampelas, M., Dalamaga, M., Karampela, I. (2020) Does COVID-19 involve the retina? Ophthalmol Ther., 1-3 https://doi.org/ 10.1007/s40123-020-00299-x.
16. Khavandi, S., Tabibzadeh, E., Naderan, M., Shoar, S. (2020). Corona virus disease-19 (COVID-19) presenting as conjunctivitis: atypically high-risk during a pandemic. Contact Lens & Anterior Eye, 43(3); 211-212.
17. Landecho, M.F., Yuste, J.R., Gandara, E, Sunsundegui, P., Quiroga, J., Alcaide, A.B., Garcia-Layana, A. (2020) COVID-19 retinal microangiopathy as an invivo biomarker of systemic vascular disease. J. Int. Med., https://doi.org/10.1111/joim.13156.
18. Li, J., O., Lam, D., S., C., Chen, Y., Ting, D., S., W. (2020). Novel coronavirus disease 2019 (COVID-19): the importance of recognising possible early ocular manifestation and using protective eyewear. Br J Ophthalmol, 104(3):297–298.
19. Lu, C., W., Liu, X., F., Jia Z., F. (2020). “2019-nCoV transmission through the ocular surface must not be ignored. The Lancet, 395(10224);39.
20. Lu, H., Stratton, C.W., Tang, Y.W. (2020). Outbreak of pneumonia of unknown etiology in wuhan China: the mystery and the miracle.. J. Med. Virol, 92(4):401–402.
21. Marchetti, M. (2020) COVID-19-driven endothelial damage: Complement, HIF-1, and ABL2 are potential pathways of damage and targets for cure. Ann. Hematol., 99:1701–1705.
22. Marinho, P.M., Marcos, A.A., Romano, A.C., Nascimento, H., Belfort J.R. (2020) Retinal findings in patients with COVID-19. Lancet, 395(10237):1610-1616.
23. Navel, V., Chiambaretta, F., Dutheil, F. (2020). Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2. American journal of ophthalmology case reports, 19, 100735. https://doi.org/10.1016/j.ajoc.2020.100735. Otaif, W., Al Somali, A., I., Al Habash, A. (2020), Episcleritis as a possible presenting sign ofthe novel coronavirus disease: A case report. Am. J. Ophthalmol. https://doi.org/10.1016/j.ajoc.2020.100917.
24. Pereira, L.A., Mansano Soares, L.C., Nascimento, P.A., Cirillo, N.L.R., Sakuma, H.T., Veiga, G.L.,…Abucham-Neto, J.Z. (2020) Retinal findings in hospitalised patients with severe COVID-19. Br. J Ophthalmol. DOI: 10.1136/bjophthalmol-2020-317576.
25. Port, A., D., Orlin, A., Kiss, S., Patel, S., D'Amico, D., J., Gupta, M., P. (2017). Cytomegalovirus retinitis: a review. J Ocul Pharmacol Ther, 33(4):224–234.
26. Savastano, A., Crincoli, E., Savastano, M.C., Younis, S., Gambini, G., De Vico, U.,…Rizzo, S. (2020) Peripapillary Retinal Vascular Involvement in Early Post-COVID-19 Patients. Journal. Clin. Med., 9(9):2895.
27. Scalinci, S. Z., Trovato Battagliola, E. (2020). Conjunctivitis can be the only presenting sign and symptom of COVID-19. IDCases, 20, e00774, https://doi.org/10.1016/j.idcr.2020.e00774.
28. Seah, I., Anderson, D. E., Kang, A., Wang, L., Rao, P., Young, B. E., Lye, D. C., Agrawal, R. (2020). Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019 (COVID-19) Patients. Ophthalmology, 127(7), 977–979. https://doi.org/10.1016/j.ophtha.2020.03.026–594. https://doi.org/10.1002/jmv.25725.
29. Senanayake, P., Drazba, J., Shadrach, K., Milsted, A., Rungger-Brandle, K., Nishiyama, K., Miura, S., I.,…, Hollyfield, J., G. (2007). Angiotensin II and its receptor subtypes in the human retina. Invest Ophthalmol Vis Sci, 48(7):3301–3311.
30. Strain, W. D. ve Chaturvedi, N. (2002). Review: the renin-angiotensin-aldosterone system and the eye in diabetes. Journal of the Renin-Angiotensin-Aldosterone System, 3(4):243–246.
31. Vavvas, D.G., Sarraf, D., Sadda, S.R., Eliott, D., Ehlers, J.P., Waheed, N.,…Miller J.B. (2020) Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent Lancet publication. Eye, https://doi.org/10.1038/s41433-020-1084-9.
32. Virgo, J., Mohamed, M. (2020) Paracentral acute middle maculopathy and acute macular neuroretinopathy following SARS-CoV-2 infection. Eye, 34:2352-2353.
33. Wu, P., Duan, F., Luo, C., Liu, Q., Qu, X., Liang, L., Wu, K. (2020). Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmology, 138(5);575–578.
34. Xia, J., Tong, J., Liu, M., Shen, Y., & Guo, D. (2020). Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. Journal of medical virology, 92(6), 589 .
35. Zhang, Y.,Xiao, M., Zhang, S., Xia, P., Cao, W., Jiang, W.,…Zhang S. (2020) Coagulopathy and antiphospholipid antibodies in patients with COVID-19. New England Journal of Medicine, ;382(17):e38.