Experience against COVID-19 Pandemic in Ophthalmology
Journal of Clinical and Experimental Ophthalmology is a journal which provides rapid peer-review process with 6 issues per year (Bi Monthly). Journal of Clinical and Experimental Ophthalmology accepts all types of articles including case-reports, research, review, case-series, mini-review, opinion articles, short communications, commentary, perspective and video articles.
Journal of Clinical and Experimental Ophthalmology has recently release its 3rd issue in 2020 with 6 articles and 3 Research articles, 2 case reports and a short communication. Here we are mentioning about the case report entitled “Experience against COVID-19 Pandemic in Ophthalmology” written and submitted by Xufang Sun whose abstract was as follows:
The 2019 novel coronavirus disease (COVID-19) pandemic has now emerged signs of stable or in control, especiallyin China. Several studies have been conducted to identify the possible ocular route of SARS-CoV-2 infection and theocular symptoms in COVID-19 patients. Due to the close contact with patients when performing ophthalmologicexaminations or surgeries, ophthalmologists need precautionary measures during the outbreak. Here, we summarizeresearches on COVID-19 related ocular characteristics and the experience against the SARS-CoV-2 infection, hopingto help ophthalmologists and patients worldwide.
The transmission of SARS-CoV-2 via the ocular surface eyesshould not be overlooked. It has been proved that the entry ofSARS cov-2 is mediated by angiotensin converting enzyme 2(ACE2), a metallopeptidase expressed in many human tissues,including the cornea and conjunctiva [1,2]. Besides, a novelroute of CD147 (extracellular matrix metalloproteinase inducer)-spike protein (SP) was found in promoting SARS-CoV-2invasion into host cells . CD147 was also detected in cornea,conjunctiva and retina . Further study of animal modelshowed that macaques could be infected with SARS-CoV-2 viathe conjunctival route and the viruses spread in bothnasolacrimal system and lung . These results provide amolecular basis for the transmission of SARS-CoV-2 through theeyes.A lot of case reports and observational studies suggested thatconjunctival congestion was one of the symptoms of COVID-19,and could appear as the initial symptom [6-9]. Our paper, titled“Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: A cross-sectional study”,enrolled 535 patients at Mobile Cabin Hospital and TongjiHospital with mild COVID-19. 5.0% patients had conjunctivalcongestion during hospitalization. Moreover, the averageduration of conjunctival congestion was 5.9 ± 4.5 days (mean[SD]). We further investigated the behaviors of eye protection,showing that frequent hand-eye contact may be the risk factorfor conjunctival congestion in COVID-19 patients. For thesepatients with conjunctivitis, the usage of ganciclovir eye drop waseffective.Except for the ocular manifestations of conjunctivitis, such asconjunctival congestion, chemosis, increased watery secretions ortearing, no symptom and lesion associated with intraoculardiseases (iritis, choroiditis, and retinal disease) was found inCOVID-19 patients, which suggested that the illness seemed toconfine to the ocular surface [7,9,10]. Recent researches hasproved that SARS-CoV-2 spike (S)-protein binds ACE2, and inconcert with host proteases, principally TMPRSS2, promotescellular entry . Co-expression of ACE2 and TMPRSS2 wasdetected in conjunctiva and cornea but not in retina, inaccordance with the clinical symptoms . Thus, screening ofpatients with ocular surface discomforts by ophthalmologists isadvocated during the outbreak of COVID-19.In the early stage of the epidemic in Wuhan, China, most of theinfected medical staffs worked not in respiratory or emergencydepartment but in neurosurgery or ophthalmology departments.
Due to the close contact with patients when performingophthalmologic examinations and frequent exposure to oculardischarge, ophthalmologists should pay attention to theprotections during medical practice or surgeries and thepossibility of cross-infection.For patients, online doctor visit via smartphone could helpreducing face-to-face contact. If the preliminary treatments failto relieve the ocular discomforts, patients are then asked tomake an appointment on “Tongji hospital” application beforegoing to the clinic. All patients are advised to wear maskseverywhere in hospital and they are firstly screened throughtemperature measurement and symptoms at emergencydepartment. A series of examinations, including blood routine,COVID-19 IgM/IgG detection, SARS-CoV-2 detection innasopharyngeal swabs and chest CT are needed for patients withhigh temperature, respiratory symptoms, close contact withCOVID-19 diagnosed patients or before ocular surgery.
Journal of Clinical and Experimental Ophthalmology
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