BREAKING COVID-19 News! Study Claims That Omicron Infections Can Lead To Acute Primary Angle Closure And Also Primary Angle Closure Glaucoma!

COVID-19 News: The intricate relationship between COVID-19 and its impact on various organ systems has been a subject of intense scrutiny since the virus's emergence in 2019. A recent groundbreaking study covered in this COVID-19 News report, conducted at the Shanghai Medical College, Fudan University-China, has added a new dimension to this exploration. The research investigates the surge in cases of Acute Primary Angle-Closure (APAC) during the COVID-19 Omicron variant pandemic in Shanghai, suggesting a potential link between viral infections and acute eye conditions. This retrospective observational study not only delves into the clinical characteristics of affected patients but also explores the possible mechanisms underlying this intriguing association.


Acute Primary Angle-Closure (APAC)
 
Thailand Medical News had previously covered another study that also showed that SARS-CoV-2 could be responsible for a rise in glaucoma cases.
 
https://www.thailandmedical.news/news/breaking-covid-19-news-chinese-study-discovers-that-sars-cov-2-increases-the-risk-for-developing-acute-angle-closure-glaucoma
 
Contextualizing COVID-19 and Ocular Manifestations
COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initially identified in December 2019, has since evolved into a global health crisis. While primarily known for its respiratory impact, the virus has demonstrated its ability to affect various organ systems, including the eyes.
 
Ophthalmologists worldwide have reported a spectrum of ocular manifestations in COVID-19 patients, ranging from mild conjunctivitis to severe complications.
The infection, which spread rapidly across the globe, has prompted researchers to explore its impact on the eyes comprehensively. Beyond the commonly reported conjunctivitis, cases of viral keratoconjunctivitis, episcleritis, retinal vein occlusion, acute retinal necrosis, choroiditis, and neuro-ophthalmic manifestations have been documented. Notably, reports from different parts of the world have indicated an increased incidence of acute angle-closure attacks during hospitalization or after prone positioning in COVID-19-positive patients.
 
Study Design and Methodology
The study conducted at the Eye, Ear, Nose, and Throat Hospital of Fudan University in Shanghai employed a retrospective observational design to explore the outbreak of APAC during the COVID-19 Omicron variant pandemic. The research spanned from December 15, 2022, to January 14, 2023, a period marked by a significant increase in COVID-19 Omicron variant infections in Shanghai. A control group, comprising cases from November 15 , 2021, to February 14, 2022, when the infection rate of COVID-19 was very low in Shanghai, provided a baseline for comparison.
 
The key parameters studied included demographic features, intraocular pressure, axial length, anterior chamber depth, lens thickness, and pupil diameter. By comparing these aspects between the pandemic and control groups, researchers sought to discern any significant patterns or variations that could shed light on the potential association between COVID-19 Omicron variant infections and APAC.
 
Incidence and Onset Patterns
The study revealed a stark increase in the incidence of APAC during the COVID-19 Omicron variant surge, with the number of affected patients and eyes surging 8.92-fold and 9.55-fold, respectively, compared to the control group. The onset of acute angle-closure predominantly occurred between December 17 and December 31, 2022, closely aligning with the peak of the Omicron variant outbreak in Shanghai.
 
Interestingly, a significant proportion (72.65%) of the patients diagnosed with APAC during the pandemic had a recent history of COVID-19 infection. Moreover, within this subset, 72% experienced APAC attacks within 24 hours of the onset of COVID-19 symptoms, while an overwhelming 92% reported attacks within three days. This temporal correlation raises intriguing questions about the potential connection between the onset of APAC and new COVID-19 Omicron variant infections.
 
Comparative Analysis of Demographic Characteristics
A meticulous comparative analysis between the pandemic and control groups revealed striking similarities in demographic characteristics, including age, gender distribution, and laterality of affected eyes. Despite the surge in cases during the pandemic, the age and gender ratios remained consistent, suggesting that the population affected during the COVID-19 Omicron variant pandemic mirrored that of the previous year.
 
Ocular Biometry and Treatment Timelines
In examining ocular biometry, the study found no significant differences in parameters such as axial length, anterior chamber depth, and lens thickness between the pandemic and control groups. However, the time from the onset of symptoms to treatment emerged as a critical differentiator. The pandemic group experienced a significantly longer delay in seeking treatment, with a median of 7.92 days compared to the control group's 3.63 days. This delay was particularly pronounced in COVID-19-positive patients within the pandemic group, where the time from symptoms to treatment averaged 8.42 days.
 
Another noteworthy finding was the larger pupillary diameter observed in the pandemic group, especially among COVID-19-positive patients. The average pupil diameter was 4.53 ± 1.17 mm in the pandemic group, contrasting with 3.78 ± 1.24 mm in the control group. This difference raises questions about the potential influence of COVID-19 Omicron variant infections on ocular physiology, specifically the pupillary response.
 
Discussion: Unraveling the Mechanisms
The observed outbreak of APAC during the COVID-19 Omicron variant pandemic raises several intriguing questions that demand a nuanced exploration of potential mechanisms. While the study provides essential insights, the exact reasons behind the correlation between the viral infection and acute eye conditions remain elusive.
 
Multiple factors could contribute to the increased incidence of APAC during the pandemic, ranging from anatomical predispositions to the characteristics of the Omicron variant itself. The pandemic's psychological impact, reflected in heightened anxiety levels, delayed treatment-seeking behavior, and alterations in lifestyle during lockdowns, could also play a role in the observed patterns.

The larger pupillary diameter in COVID-19-positive patients suggests a potential influence of the viral infection on ocular physiology. Delayed treatment in this subset may exacerbate the effects of elevated intraocular pressure, leading to more severe iris ischemia and pupillary sphincter damage, ultimately resulting in a larger pupil.
 
Conclusion: Towards a Deeper Understanding
In conclusion, the study conducted at the Eye, Ear, Nose, and Throat Hospital of Fudan University provides a comprehensive exploration of the surge in APAC during the COVID-19 Omicron variant pandemic in Shanghai. The findings underscore the need for further research to unravel the complex relationship between COVID-19 infections, specifically the Omicron variant, and ocular complications.
 
As the world navigates through the evolving landscape of the COVID-19 pandemic, understanding the diverse manifestations of the virus becomes paramount for holistic healthcare. This study contributes to the growing body of knowledge, urging the scientific community to delve deeper into the intricacies of COVID-19's impact on ocular health. Long-term observations, multi-center studies, and detailed investigations into the potential pathophysiological mechanisms are essential for painting a more comprehensive picture of the intersection between COVID-19 and ocular complications, particularly acute primary angle-closure.
 
The study findings were published in the peer reviewed journal: Dove Press.
https://www.dovepress.com/the-outbreak-of-acute-primary-angle-closure-cases-during-the-covid-19--peer-reviewed-fulltext-article-OPTH
 
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