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• COVID-19 and immunosuppression in ophthalmic disorders
  Anadi Khatri
  Published on: 13 June 2020

• Published on: 13 June 2020

  COVID-19 and immunosuppression in ophthalmic disorders

  • Anadi Khatri, Vitreoretina Consultant Birat Eye Hospital

  The review article by Thng ZX, De Smet MD, Lee CS, et al 1highlights the most intriguing aspects on use of immunosuppressants during and post COVID-19 pandemic. The authors have presented evidences based on various reports in a very well-structured manner and we would like to first thank and congratulate the authors for their work. The review covers the wide range of faculties of medicine where immune suppression is likely to be the main stay of treatment. At the same time, they have also very neatly presented with the “clear cut “ guidelines on the dosing of these various medications at different scenarios and patient status.

  While the article additionally covers the following aspects very well ;

  1) Does the use of immunosuppressive present as an independent risk factor for contracting COVID -19 in patients under them?
  2) Does it affect the severity of COVID -19 ?

  We have few inquiries to make to the authors regarding the use of immunosuppressive in ophthalmology during this difficult time.

  The authors have used the term “high dose steroids” in their article. Firstly, we are curious to understand what would be the considered the criteria to define a “high dosage” of steroid in ophthalmology. From our understanding, it depends upon the class of steroid used and the body weight2 but should we also need to consider the duration of use and cumulative dosage over a stretch of time to define it?

  Also, referring to various public...

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  The review article by Thng ZX, De Smet MD, Lee CS, et al 1highlights the most intriguing aspects on use of immunosuppressants during and post COVID-19 pandemic. The authors have presented evidences based on various reports in a very well-structured manner and we would like to first thank and congratulate the authors for their work. The review covers the wide range of faculties of medicine where immune suppression is likely to be the main stay of treatment. At the same time, they have also very neatly presented with the “clear cut “ guidelines on the dosing of these various medications at different scenarios and patient status.

  While the article additionally covers the following aspects very well ;

  1) Does the use of immunosuppressive present as an independent risk factor for contracting COVID -19 in patients under them?
  2) Does it affect the severity of COVID -19 ?

  We have few inquiries to make to the authors regarding the use of immunosuppressive in ophthalmology during this difficult time.

  The authors have used the term “high dose steroids” in their article. Firstly, we are curious to understand what would be the considered the criteria to define a “high dosage” of steroid in ophthalmology. From our understanding, it depends upon the class of steroid used and the body weight2 but should we also need to consider the duration of use and cumulative dosage over a stretch of time to define it?

  Also, referring to various publications , the definition also seems to vary even if the class of steroids are same but administered via a different route2,3 . Most likely it is related to the bioavailability but the term “high dose” in general, really seems to be creating a confusion to ophthalmologists. 4

  Since the authors of this review are also the renowned key members of the various uveitis societies and have been involved in preparing protocols and guidelines , we like to draw their attention to revisit the issue and reach a consensus to use the term “high dose “ more judiciously by providing it with a more categorical definition.

  On a final note, while the authors have advised to keep steroids/immunomodulators as low as possible, we would like to inquire on what are the recommendations for pathologies – such as retinal vasculitis, VKH ,SO , Optic neuritis ,traumatic optic neuropathy ,etc. which require “high dosage” or “mega- dosage” in a pulsed or a non-pulsed manner. 2,3,5 It would be of great value for clinicians around the world if the authors could provide their recommendations on such entities.

  Reference:
  1. Thng ZX, De Smet MD, Lee CS, et al COVID-19 and immunosuppression: a review of current clinical experiences and implications for ophthalmology patients taking immunosuppressive drugs British Journal of Ophthalmology Published Online First: 12 June 2020. doi: 10.1136/bjophthalmol-2020-316586.
  2. Sherif Z, Pleyer U: Corticosteroids in Ophthalmology: Past – Present – Future. Ophthalmologica 2002;216:305-315. doi: 10.1159/000066189.
  3. Charkoudian LD, Ying GS, Pujari SS, et al. High-dose intravenous corticosteroids for ocular inflammatory diseases. Ocul Immunol Inflamm. 2012;20(2):91‐99. doi:10.3109/09273948.2011.646382.
  4. Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev. 2011;(1):CD006032. Published 2011 Jan 19. doi:10.1002/14651858.CD006032.pub3.
  5. O’Keefe GA, Rao AN. Vogt–Koyanagi–Harada disease. Surv Ophthalmol. 2017;62(1):1–25.

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  Conflict of Interest:
  None declared.

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