Clinical characteristics of acute primary angle closure following COVID-19 during the Omicron outbreak in China

The global pandemic of coronavirus disease 2019 (COVID-19) has been associated with diverse ocular manifestations, yet its potential link with acute primary angle closure (APAC) remains poorly characterized, particularly during the Omicron variant wave. The aim of the present study was to explore the clinical characteristics of APAC following COVID-19 infection during the Omicron epidemic period in China. A retrospective comparison was conducted between patients with APAC who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid within 15 days before APAC onset (post-COVID-19 group; December 2022 to January 2023), and patients with APAC from the same seasonal period before the pandemic (pre-pandemic group; December 2018 to January 2019). The pre-pandemic group comprised 50 eyes of 48 patients, and the post-COVID-19 group comprised 86 eyes of 78 patients. Demographic, clinical and treatment data were compared between the two groups. The post-COVID-19 group exhibited a significantly deeper anterior chamber depth (ACD) and thinner lens. The post-COVID-19 group also exhibited more extensive angle closure with less frequent ciliary body detachment and a lower proportion of patients treated with glucocorticoid eyedrops. Although patients in the post-COVID-19 group presented with a greater ACD than those in the pre-pandemic group, the ACDs of both groups were within the clinically shallow range. This suggests a potential pathophysiological mechanism involving anterior chamber angle obstruction and inflammation, possibly triggered by SARS-CoV-2 infection, rather than pure pupillary block. Therefore, it is recommended that ophthalmologists should be vigilant for APAC in patients post-infection with COVID-19, even in those with only moderately shallow anterior chambers.