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Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease
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  • Published on: 16 June 2020
    Retinal involvement in Covid-19 would probably be missed.
    • Rachid TAHIRI JOUTEI HASSANI, Ophthalmologist Ambulatory Surgery Department, Avranches Granville Hospital
    • Other Contributors:
      • Nathalie MASSAMBA, Ophthalmologist

    Dear Editor,
    We have read the clinical case report entitled “Ocular manifestations of a patient hospitalized with a new coronavirus disease confirmed in 2019” by Chen L, et al.1 We congratulate the authors for this important work and wish to share our comment concerning the retinal findings. The authors indicated that Spectral-domain optical coherence tomography (SD-OCT) imaging was normal in both eyes. However, we would like to highlight the presence of hyper-reflective focal points at the level of the internal plexiform layer (IPL) and the ganglion cell layer (GCL). The report later published by Marinho PM, et al. in Lancet on May 12, 2020 "Retinal findings in patients with COVID-19" described the presence of focal hyperreflective dots at the IPL and GCL levels in all patients (24 eyes of 12 patients), which was the first report of SD-OCT retinal abnormalities in patients with COVID 19.2 We compared the two SD-OCT images published by Chen L, et al. to those published by Marinho PM, et al. All images were reviewed by two different retina specialists (NM, RTJH), and our analysis was strongly consistent. We have implemented the algorithm using the Python script3 to adjust the size and resolution of the images, and flipped the C by Marinho PM, et al. using fovea as the reference to obtain comparable images. We overlaid the images published by Chen L, et al. with those published by Marinho PM, et al. We were able to demonstrate that the hyperreflective lesions...

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    Conflict of Interest:
    None declared.
  • Published on: 29 May 2020
    Comment on Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease
    • Dewang Angmo, Ophthalmologist Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS
    • Other Contributors:
      • Karthikeyan Mahalingam, Senior Resident, Ophthalmology
      • Rohit Saxena, Professor, Ophthalmology

    At the outset, we would like to congratulate the authors for determining the presence of the viral RNA over time in conjunctival specimens of a patient with COVID-19, which was much needed.
    The clinical course of viral conjunctivitis is self-limiting. Usually only supportive treatments like cold compress, artificial tears and topical steroids are given. The time duration taken for symptoms to subside without treatment ranges from 4-6 days to 2-3 weeks, depending upon the type of disease.[1] Clinical studies regarding the usage of antivirals for conjunctivitis reveal that they were effective only for DNA viruses and was not free of toxicity.[2]
    In the case report regarding ocular manifestation of patient with 2019 novel corona virus disease,[3] the ocular symptoms of patient resolved after 5 days of its onset and the author claims it to be possibly due to treatment with ribavirin eye drops. As Corona virus is a RNA virus, we believe that antiviral therapy would have been limited use. Adequate corneal tissue levels of antiviral agents are achieved by both topical and systemic administration.[4] If antiviral therapy was the reason for improvement of ocular symptoms, the patient was on three oral antiviral drugs (Umifenovir, lopinavir and ritonavir) in addition to topical ribavirin. Therefore, attributing only topical ribavirin for curing ocular symptoms may not be appropriate with the limited evidence.
    The authors also had mentioned that sterile synthetic f...

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    Conflict of Interest:
    None declared.