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Acute primary angle closure concurrent with coronavirus disease 2019 recurrence in Northern China: A retrospective
Ye Zhang1, Su Jie Fan2, Xiao Jing Pan3
1Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Insights
Acute primary angle closure (APAC) cases increased post-COVID-19 restrictions, with younger patients and distinct ocular characteristics observed. Further research is needed to understand COVID-19
Area of Science:
- Ophthalmology
- Public Health
- Infectious Diseases
Background:
- The COVID-19 pandemic and associated restrictions have been linked to changes in patient presentation for various medical conditions.
- Acute primary angle closure (APAC) is an ophthalmic emergency that can lead to vision loss if not treated promptly.
- Previous observations suggested an increase in APAC during the initial COVID-19 outbreak period.
Purpose of the Study:
- To determine the incidence of APAC during the COVID-19 post-restriction period.
- To investigate the specific characteristics of patients presenting with APAC after COVID-19 restrictions.
- To explore potential correlations between COVID-19 infection, symptoms, and APAC development.
Main Methods:
- Retrospective, multi-center study comparing APAC patients from a post-restriction period (Dec 2022-Jan 2023) with a control period (Dec 2021-Jan 2022).
- Analysis of ocular data from electronic medical records for patients with APAC.
- Questionnaire-based data collection on COVID-19 symptoms, treatments, lifestyle, and emotional state during the post-restriction period.
Main Results:
- A significant increase in APAC cases was observed during the post-restriction period (189 patients) compared to the control period (51 patients).
- Patients in the post-restriction period were younger and exhibited shorter axial length, larger pupils, and more advanced glaucomatous changes.
- Among patients with concurrent COVID-19, coughing/vomiting were common symptoms, with reduced outdoor activity, increased water intake, antipyretic use, and mood swings reported.
Conclusions:
- The study confirms a notable rise in APAC cases with specific demographic and ocular features following COVID-19 restrictions.
- The findings suggest a potential link between COVID-19 infection, its symptoms (e.g., coughing, vomiting), and behavioral changes with APAC.
- Further investigation is warranted to elucidate the causal relationship between COVID-19 and APAC recurrence or onset.
Aims And Objectives:
During the new coronavirus disease 2019 (COVID-19) outbreak period, there was increasing presentation in the number of patients with acute primary angle closure (APAC). This study aimed to report the occurrence of APAC during the COVID-19 post-restriction period and investigate the related characteristics of these patients with APAC.
Methods:
This retrospective, multi-center study included consecutive patients seeking APAC treatment at two eye centers in China from December 7, 2022 to January 13, 2023 (post-restriction period) and from December 7, 2021 to January 13, 2022 (control period). Electronic medical records were reviewed, and ocular data of the affected eye(s) were analyzed for patients with unilateral or bilateral APAC. Information including COVID-19 related symptoms, medications used for COVID-19 infection, and living habits and emotions related to the COVID-19 outbreak during the post restriction period were collected using a questionnaire.
Results:
Overall, 189 (219 APAC eyes) and 51 (54 APAC eyes) patients with APAC were identified during the post-restriction and control periods, respectively. The patients identified during the post-restriction period were younger (P = 0.043) and had a longer duration from symptoms to treatment (P = 0.039), shorter axial length (P = 0.002), larger pupil diameter (P = 0.004), larger vertical cup disc ratio (P = 0.004), poorer mean deviation values (P = 0.003), and more glaucomatous optic neuropathy diagnoses (P = 0.032) compared with the patients with APAC identified during the control period. Among 151 included patients with APAC who completed the questionnaires, 130 patients with APAC were diagnosed with concurrent COVID-19 infection, of which 54 (41.5 %) had coughing and/or vomiting as the main symptoms. Of these, 89.2 % spent 0 h per day on outdoor activity; 44.6 % drank more water than usual, with 14.6 % drinking more than twice the amount of water than usual; 91.5 % used antipyretics; and 20.0 % had mood swings, including anxiety, depression, and tension, during the concurrent COVID-19 infection.
Conclusion:
In our study, a significant increase in the number of patients presenting with APAC with certain characteristics was observed during the COVID-19 post-restriction period. And whether COVID-19 symptoms, such as coughing and vomiting, and behavioral and psychological changes caused by COVID-19 infection contributing to the concurrence of APAC and COVID-19 recurrence require further investigation.
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