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      Retinal findings in patients with COVID-19

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          Abstract

          Coronavirus disease 2019 (COVID-19) has been shown to affect different parts of the body, and ophthalmological changes have been associated with ocular external diseases such as conjuntivitis 1 . Optical coherence tomography (OCT) is a non-invasive imaging technique that is useful for demonstrating subclinical retinal changes in systemic conditions such as diabetes, Parkinson's disease, and Alzheimer's disease, as well as many viral infections. 2 We used OCT to evaluate patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The protocol was approved by INVIRARE Pesquisa Clínica Auditoria e Consultoria Institutional Review Board Ethics Committee. Here we report retinal and OCT changes in 12 adults (six men and six women, aged 25–69 years), examined 11–33 days after COVID-19 symptom onset. All patients had fever, asthenia, and dyspnoea, and 11 patients also presented with anosmia. Two patients were admitted to hospital but none required intensive care. Nine patients were physicians, and two were health-care workers. All patients had normal blood parameters at the time of ophthalmological evaluation. Nine patients tested positive for SARS-CoV-2 by PCR (using nasal and oral swabs), and two patients tested positive in antibody tests for COVID-19. Two different OCT devices were used: DRI-OCT Triton Swept Source (Topcon, Tokyo, Japan) and XR Avanti SD-OCT (Optovue, Fremont, CA, USA). All patients showed hyper-reflective lesions at the level of ganglion cell and inner plexiform layers more prominently at the papillomacular bundle in both eyes (figure ). Results of OCT-angiography and ganglionar cells complex analysis appeared normal. Furthermore, four patients presented subtle cotton wool spots and microhaemorrhages along the retinal arcade, observed on fundus examination, color fundus photography, and red-free imaging. Visual acuity and pupillary reflexes were normal in all eyes, and we detected no symptoms or signs of intraocular inflammation. Figure Retinal findings in four patients with COVID-19 Panels A-D represent four different patients. (A) Colour fundus photography and red-free imaging show a cotton wool spot at the superior retinal arcade with subtle microhaemorrhage. (B–D) Cross-sectional B-scan OCT in three patients shows hyper-reflective lesions at the level of the inner plexiform and ganglion cell layers, a feature observed in all patients. COVID-19=coronavirus disease 2019. OCT=optical coherence tomography. Although animal models suggest ocular lesions could include retinitis and optic neuritis,3, 4 this is, to the best of our knowledge, the first report of retinal findings possibly associated with COVID-19 infection in humans. Ganglion cell and plexiform layer findings could be associated with CNS manifestations that have been described in animal studies 4 and in COVID-19 neurological events. 5

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          A first case of meningitis/encephalitis associated with SARS-Coronavirus-2

          Highlights • Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly. • This is the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance. • The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF. • This case warns the physicians of patients who have CNS symptoms.
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            Is Open Access

            Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China

            Key Points Question What are the ocular manifestations and conjunctival viral prevalence in patients from Hubei province, China, with coronavirus disease 2019 (COVID-19)? Findings In this case series including 38 patients with COVID-19, 12 patients had ocular manifestations, such as epiphora, conjunctival congestion, or chemosis, and these commonly occurred in patients with more severe systemic manifestations. Reverse transcriptase–polymerase chain reaction results were positive for severe acute respiratory syndrome coronavirus 2 in 28 nasopharyngeal swabs and 2 conjunctival swabs, and more significant changes in blood test values appeared in patients with ocular abnormalities. Meaning These data may assist ophthalmologists and others to understand the ocular manifestations of COVID-19, thus enhancing the diagnosis and prevention of the transmission of the disease.
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              Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals

              ABSTRACT In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus – 2 (SARS-CoV-2) emerged from China. This virus causes the coronavirus disease 2019 (COVID-19). Since then, there have been anecdotal reports of ocular infection. The ocular implications of human CoV infections have not been widely studied. However, CoVs have been known to cause various ocular infections in animals. Clinical entities such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been documented in feline and murine models. In this article, the current evidence suggesting possible human CoV infection of ocular tissue is reviewed. The review article will also highlight animal CoVs and their associated ocular infections. We hope that this article will serve as a start for further research into the ocular implications of human CoV infections.
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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier Ltd.
                0140-6736
                1474-547X
                12 May 2020
                12 May 2020
                Affiliations
                [a ]Instituto Paulista de Estudos e Pesquisas em Oftalmologia, São Paulo, Brazil
                [b ]Instituto da Visão, Federal University of São Paulo, São Paulo 04023-062, Brazil
                Article
                S0140-6736(20)31014-X
                10.1016/S0140-6736(20)31014-X
                7217650
                32405105
                09588353-51c0-4f61-82b2-e83b27648311
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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