Visus 6 15

[Kenneth]

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Background: The novel coronavirus disease 2019 (COVID-19) and its rapid spread has resulted in unexplored clinical ophthalmological manifestations. This report aims to describe a series of retinal vascular anomalies diagnosed with the use of fluorescein angiography, following contraction of COVID-19.

Therapy and outcome: Clinical manifestations included bilateral retinal vasculitis (two cases), branch retinal vein occlusion (one case), branch retinal artery occlusion (one case), hemi-central retinal vein occlusion (one case), and optic disc edema due to central retinal vein occlusion (one case) occurring 0 - 8 months after COVID-19 contraction. Serological testing was performed in every patient to exclude any other recognized cause of retinal vascular occlusion and inflammation and to confirm immunity against the novel coronavirus. None of the patients required any ocular treatment.

Conclusions: Arterial and venous occlusive as well as inflammatory retinal vascular pathologies can occur both during and after the acute phase of COVID-19 as manifestations of ocular long-term effects of COVID-19 and should be included in the differential diagnosis of retinal occlusive pathologies. This case series suggests that careful investigations, including fundoscopy and fluorescein angiography, should be required in patients with visual complaints, both in the acute and long-term follow-up of COVID-19.

Hintergrund: Die neuartige Coronavirus-Krankheit 2019 (COVID-19) und ihre schnelle Ausbreitung fhrten zu unerforschten klinischen ophthalmologischen Manifestationen. Dieser Bericht zielt darauf ab, eine Reihe von retinalen vaskulren Anomalien zu beschreiben, die mithilfe der Fluorescein-Angiografie diagnostiziert wurden nach der Kontraktion durch COVID-19.

Vorgeschichte und anzeichen: Die von den Patienten berichteten Symptome waren ein zentrales Skotom (1 Fall), ein inferiores Skotom (1 Fall) und das Gefhl eines leichten Sehverlustes whrend der COVID-19-Nachuntersuchung (4 Flle). Die bestkorrigierte Sehschrfe war bei allen Patienten erhalten, bis auf einen, der einen Visus von 0,4, Dezimalskala (6/15, Snellen) auf dem linken Auge hatte.

Schlussfolgerungen: Arterielle und vense okklusive sowie entzndliche retinale Gefpathologien knnen sowohl whrend als auch nach der akuten Phase von COVID-19 als Manifestationen von okulren Langzeiteffekten von COVID-19 auftreten und sollten in die Differenzialdiagnose von retinalen Okklusionspathologien einbezogen werden. Diese Fallserie legt nahe, dass bei Patienten mit Sehbeschwerden sowohl in der akuten als auch in der langfristigen Nachsorge von COVID-19 sorgfltige Untersuchungen, einschl. Funduskopie und Fluorescein-Angiografie, erforderlich sein sollten.

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The aim of the study was to report a case of acute toxic optic neuropathy. A case report of a 29 years old female with acute visual loss in both eyes. There was history of taking multiple drugs about 4 days while in the hospital. We performed visual acuities examination, light projection, color perception, funduscopy, and visual field examinations. The visual acuities were 1/300 on both eyes with bad color perceptions, the other examination were normal. Visual field examination was performed on the third day when the visual acuities were improved, showing severe depression on the both eyes and diagnosed acute toxic optic neuropathy. She is given neurotropic injection once daily, neutotropic tablet twice daily, and acetazolamide tablet 3 times daily. Retrobulber dexamethason injection on second day for 5 days, and continued with dexamethason tablet 1mg four times daily. The patients was consulted to neurology, ENT, internist, and oral medicine department. The visual acuity became better 3/60 in the both eyes on the third days, on the seventh days on the right eye 5/60 and the left eye 4/60. One week later, the visual acuity became 6/12 on the right eye and 6/15 on the left eye, but there was color deficiency in both eyes. Visual field examination of both eyes showed improvement to be moderate depression. The treatment was continued and dexamethason was tapering off. Follow up in one month the visual acuity improved to be 6/7.5 on the right eye and 6/8.5 on the left eye, although there was still green color blind with one eye. Visual field showed mild depression. Concluded a case of acute toxic optic neuropathy treated with steroid injection and orally, and neurotropic agents, there was a good result although not fully recovery.

Tujuan penulisan makalah ini adalah untuk melaporkan laporan kasus yaitu neuropati optic toksik akut. Dilaporkan kasus seorang wanita 29 tahun buta mendadak kedua matanya. Empat hari sebelum datang ke rumah sakit minum beberapa obat. Dilakukan pemeriksaan visus, proyeksi cahaya, persepsi warna, funduskopi, dan lapang pandang. Visus kedua mata 1/300 dengan persepsi warna buruk, pemeriksaan lain normal. Pemeriksaan lapang pandang dilakukan hari ke-3 saat visusnya mulai membaik. Hasilnya menunjukkan depresi berat kedua mata dan didiagnosis neuropati optic toksik akut. Diberikan terapi neurotropik injeksi sekali sehari, neurotropik tablet 2x sehari, dan asetazolamide tablet 3x sehari. Dexamethason injeksi retrobulber diberikan hari kedua selama 5 hari, dilanjutkan dengan dexamethason tablet 1mg 4x sehari. Pasien dikonsulkan ke neurologi, THT, penyakit dalam, dan dokter gigi. Visus hari ketiga membaik menjadi 3/60 pada kedua mata, hari ke- 7 menjadi 5/60 mata kanan dan 4/60 mata kiri, namun didapatkan buta warna pada kedua mata. Seminggu kemudian visus membaik menjadi 6/12 mata kanan dan 6/15 mata kiri. Lapang pandang menunjukkan depresi sedang. Terapi diteruskan dengan dexamethason tablet diturunkan dosisnya. Follow up 1 bulan kemudian menunjukkan perbaikan dengan visus 6/7.5 mata kanan dan 6/8.5 mata kiri, namun masih terdapat buta warna hijau. Pemeriksaan lapang pandang menunjukkan depresi ringan. Disimpulkan bahwa kasus neuropati optic toksik akut diterapi dengan steroid injeksi dan oral serta obat neurotropik, didapatkan perbaikan kondisi meskipun tidak sempurna.

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