News-COVID-19: Study Warns That Ocular Inflammation Present In Many Recovered Non-Hospitalized COVID-19 Patients
Researchers from the University of California-San Diego (UCSD) in a new study found that a high percentage of recovered COVID-19 patients exhibited ocular inflammation in their eyes which is a type of neuroinflammation.
The study findings by the researchers from the Department of Ophthalmology-UCSD, the Division of Infectious Diseases and Global Public Health-UCSD, and the Rady Children's Hospital-UCSD are published on a preprint server and are currently being peer reviewed. https://www.medrxiv.org/content/10.1101/2020.09.22.20128140v1
COVID-19 is typically characterized by striking variability in clinical severity, and a hyperinflammatory response in the lung is associated with high mortality.
However to date little is known about the extent and duration of inflammation in persons recovering from COVID-19.
In this research, the study team used spectral domain optical coherence tomography (SD-OCT) to detect the presence of inflammatory cells in the vitreous cavity of the eye which is an immune-privileged microenvironment, in individuals recovered from COVID- 19.
A total of fifteen participants were evaluated (6 women and 9 men). All but one was previously diagnosed with active SARS-CoV-2 infection by polymerase chain reaction (PCR) 58 to 85 days prior to evaluation.
One participant had symptoms consistent with COVID-19 and a simultaneous household contact with confirmed COVID-19. Respiratory symptoms were present in all participants (Table). Only one participant required hospitalization.
From the results of the SD-OCT scans, 4 persons had few inflammatory cells and 3 had many inflammatory cells. Participants were asked at the time of examination whether they felt they had a complete recovery. Eleven persons perceived that they are back to their baseline (median 50 days since recovery), while 4 did not (median 47 days since recovery). Of those who felt they had a complete recovery, 8 had rare inflammatory cells; while among those who had residual symptoms 2 had few inflammatory cells and 2 had many inflammatory cells. The grading scheme was applied to OCT scans from 14 individuals with no history of COVID; 13 had rare inflammatory cells and 1 had few inflammatory cells (p = 0.006)
All the participants met the criteria of recovery from the active viral phase. Time from recovery ranged from 34 to 60 days (median 50 days). Post-recovery observations: four persons reported cough, two reported lower extremity weakness and numbness, one reported headaches, and one reported photophobia
The study findings provide quasihistologic evidence that neuroinflammation is present in individuals who recovered from COVID-19.
On OCT imaging, presence of numerous inflammatory cells in the vitreous cavity is abnormal. These cells in the vitreous result from inflammation, hemorrhage or a neoplastic process. Strikingly, in two participants OCT scans prior to their COVID-19 illness showed no evidence of inflammation in the vitreous, while their scans after COVID-19 showed hyperreflective foci, strongly suggesting that even ambulatory COVID-19 may lead to inflammatory cells persisting in the eye up to 1 month after recovery.
Individual who felt that their recovery was incomplete had more cells, which likely suggests residual inflammation elsewhere.
The study findings are congruent with emerging reports demonstrating that recovery from COVID-19 may be complicated by post-viral inflammation, and full symptomatic recovery may not occur even weeks after a negative test result, even in younger individuals.
The results also suggest that persons who feel that their recovery is incomplete usually have evidence of subclinical eye inflammation, which may be a marker of residual inflammation elsewhere as well.
The study team noted that the study had limitations. The identification of inflammatory cells relied on SD-OCT imaging, and there were no molecular or cellular analysis of vitreous biopsies.
Also the specificity of this finding to COVID-19 is unknown, as no similar study to our knowledge has been conducted in persons recovering from other respiratory viral or systemic illnesses.
The team said that a larger study is needed to determine the true prevalence of vitreous cells in persons recovering from COVID-19, and a longitudinal study is needed to determine its long-term ocular health sequelae.
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