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Klin Monbl Augenheilkd 2022; 239(03): 338-345
DOI: 10.1055/a-1585-2239
Klinische Studie

Instability of Tear Film after Novel Coronavirus Disease: A Noninvasive and No Contact Method by a Scheimpflug-Placido Disc Topographer

Instabilität des Tränenfilms nach neuartiger Coronavirus-Krankheit: eine nicht invasive und berührungslose Methode vom Scheimpflug-Placido-Disc-Topographer
Yakup Acet
1   Department of Ophthalmology, Mardin State Hospital, Mardin, Turkey
,
Baris Çil
2   Department of Chest Diseases, Mardin State Hospital, Mardin, Turkey
,
Mehmet Kabak
2   Department of Chest Diseases, Mardin State Hospital, Mardin, Turkey
,
Esra Vural
3   Ophthalmology, Kayseri City Education and Research Hospital, Kayseri City Hospital, Kayseri, Turkey
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Abstract

Purpose To compare the topographical tear film break-up time (T-BUT) between individuals recovering from COVID-19 and control subjects using a noninvasive and noncontact technique with a Scheimpflug-Placido disc topographer.

Methods One-hundred and twenty-two eyes from 61 post-COVID-19 patients and 124 eyes from 62 control subjects were included in this prospective study. All participants underwent detailed ophthalmological examination including best-corrected visual acuity, intraocular pressure measurements, slit lamp examination, and fundoscopy as well as qualitative and quantitative evaluation of the noninvasive first tear film break-up time (NIF-BUT) and noninvasive average tear film break-up time (NIAvg-BUT) with T-BUT measured with a Sirius (CSO – Costruzione Strumenti Oftalmici S. r. l., Italy) corneal topography device.

Results The mean NIF-BUT in post-COVID-19 and control patients was 5.2 ± 3.4 vs. 6.5 ± 3.2 sec, respectively. The mean NIAvg-BUT in the corresponding groups was 7.5 ± 3.5 vs. 8.8 ± 3.0 sec, respectively. Both NIF-BUT and NIAvg-BUT were significantly lower in the post-COVID-19 group than in controls (p = 0.004 vs. 0.020). Topographical tear film break-up at any time during the test (17 sec) was observed qualitatively in 79 eyes (64.8%) in the post-COVID-19 group and 57 eyes (46%) in the control group (p = 0.003). Moreover, temporal quadrant involvement occurred significantly more frequently in the post-COVID-19 group (p = 0.028).

Conclusion Tear film stability assessment based on T-BUT showed shorter NIF-BUT and NIAvg-BUT in post-COVID-19 patients as compared to the control group. Our results suggest that post-COVID-19 patients have impaired stability of tear film, and therefore require closer monitoring regarding dry eye. In addition, tear film instability in post-COVID-19 patients can be reliably detected using a noninvasive and noncontact technique that is more comfortable for both patients and physicians.

Zusammenfassung

Zweck Vergleich der topografischen Tränenfilmaufbruchzeit (T-BUT) zwischen Personen, die sich von COVID-19 erholen, und Kontrollpersonen, die eine nicht invasive und berührungslose Technik mit dem Scheimpflug-Placido-Disc-Topografen verwenden.

Methoden 122 Augen von 61 Post-COVID-19-Patienten und 124 Augen von 62 Kontrollpersonen wurden in diese prospektive Studie eingeschlossen. Alle Teilnehmer wurden einer detaillierten augenärztlichen Untersuchung mit bestkorrigierter Sehschärfe, Augeninnendruckmessungen, Spaltlampenuntersuchung und Funduskopie sowie qualitativer und quantitativer Bewertung der nicht invasiven ersten Tränenfilmauflösezeit (NIF-BUT) und nicht invasiven durchschnittlichen Tränenfilmauflösezeit (NIAvg-BUT) mit T-BUT, gemessen mit einem Sirius-Hornhauttopografiegerät (CSO – Costruzione Strumenti Oftalmici S. r. l., Italien), unterzogen.

Ergebnisse Die mittlere NIF-BUT bei Post-COVID-19- und Kontrollpatienten betrug 5,2 ± 3,4 bzw. 6,5 ± 3,2 s. Die mittlere NIAvg-BUT in den entsprechenden Gruppen betrug 7,5 ± 3,5 bzw. 8,8 ± 3,0 s. Sowohl NIF-BUT als auch NIAvg-BUT waren in der Post-COVID-19-Gruppe signifikant niedriger als in der Kontrollgruppe (p = 0,004 vs. 0,020). Qualitativ wurde die T-BUT zu jedem Zeitpunkt während des Tests (17 s) bei 79 Augen (64,8%) in der Post-COVID-19-Gruppe und 57 Augen (46%) in der Kontrollgruppe (p = 0,003) beobachtet. Auch eine Beteiligung des temporalen Quadranten trat signifikant häufiger in der Post-COVID-19-Gruppe auf (p = 0,028).

Fazit Die Bewertung der Tränenfilmstabilität basierend auf der T-BUT zeigte eine kürzere NIF-BUT und NIAvg-BUT bei Patienten nach COVID-19 im Vergleich zu Kontrollgruppen. Unsere Ergebnisse legen nahe, dass Patienten nach COVID-19 eine beeinträchtigte Stabilität des Tränenfilms aufweisen und daher eine genauere Überwachung dieser Patienten in Bezug auf das trockene Auge erforderlich ist. Auch die Tränenfilminstabilität bei Post-COVID-19-Patienten kann mit einer nicht invasiven und berührungslosen Technik zuverlässig erkannt werden, die sowohl für Patienten als auch für Ärzte angenehmer ist.

Key words

novel coronavirus - tear film stability - topographic-BUT - dry eye - noninvasive BUT

Schlüsselwörter

neuartiges Coronavirus - Stabilität des Tränenfilms - topografische BUT - trockenes Auge - nicht invasive BUT


Publication History

Received: 15 June 2021

Accepted: 07 August 2021

Article published online:
21 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 World Health Organization. Novel Coronavirus (2019-nCoV) Situation Report–22. Geneva: World Health Organization; 2020
    Google Scholar
  • 2 Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet 2020; 395: e39
    CrossrefPubMedGoogle Scholar
  • 3 Xia J, Tong J, Liu M. et al. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020; 92: 589-594
    CrossrefPubMedGoogle Scholar
  • 4 Dutescu RM, Banasik P, Schildgen O. Detection of Coronavirus in Tear Samples of Hospitalized Patients With Confirmed SARS-CoV-2 From Oropharyngeal Swabs. Cornea 2021; 40: 348-350
    CrossrefPubMedGoogle Scholar
  • 5 Liang L, Wu P. There may be virus in conjunctival secretion of patients with COVID-19. Acta Ophthalmol 2020; 98: 223
    CrossrefPubMedGoogle Scholar
  • 6 Wu P, Duan F, Luo C. et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol 2020; 138: 575-578
    CrossrefPubMedGoogle Scholar
  • 7 Zulvikar SU, Gita VS. The prevalence of ophthalmic manifestations in COVID-19 and the diagnostic value of ocular tissue/fluid. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1351-1352
    CrossrefPubMedGoogle Scholar
  • 8 Gambini G, Savastano M, Savastano A. et al. Ocular Surface Impairment After Coronavirus Disease 2019: A Cohort Study. Cornea 2021; 40: 477-483
    CrossrefPubMedGoogle Scholar
  • 9 Hong N, Yu W, Xia J. et al. Evaluation of ocular symptoms and tropism of SARS-CoV-2 in patients confirmed with COVID-19. Acta Ophthalmol 2020; 98: 649-655
    CrossrefPubMedGoogle Scholar
  • 10 Chen L, Deng C, Chen X. et al. Ocular manifestations and clinical characteristics of 534 cases of COVID-19 in China: a cross-sectional study. Acta Ophthalmol 2020; 98: e951-e959
    CrossrefPubMedGoogle Scholar
  • 11 Wolffsohn JS, Arita R, Chalmers R. et al. TFOS DEWS II diagnostic methodology report. Ocul Surf 2017; 15: 539-574
    CrossrefPubMedGoogle Scholar
  • 12 Craig JP, Nichols KK, Akpek EK. et al. TFOS DEWS II definition and classification report TFOS DEWS II definition and classification report. Ocul Surf 2017; 15: 276-283
    CrossrefPubMedGoogle Scholar
  • 13 Erickson S, Sullivan AG, Barabino S. et al. TFOS European ambassador meeting: unmet needs and future scientific and clinical solutions for ocular surface diseases. Ocul Surf 2020; 18: 936-962
    CrossrefPubMedGoogle Scholar
  • 14 Chen L, Liu M, Zhang Z. et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol 2020; 104: 748-751
    CrossrefPubMedGoogle Scholar
  • 15 Hamming I, Timens W, Bulthuis ML. et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203: 631-637
    CrossrefPubMedGoogle Scholar
  • 16 Alves M, Angerami RN, Rocha EM. Dry eye disease caused by viral infection: review. Arq Bras Oftalmol 2013; 76: 129-132
    CrossrefPubMedGoogle Scholar
  • 17 Giannaccare G, Vaccaro S, Mancini A. et al. Dry eye in the COVID- 19 era: how the measures for controlling pandemic might harm ocular surface. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2567-2568
    CrossrefPubMedGoogle Scholar
  • 18 Zhang X, Chen X, Chen L. et al. The evidence of SARS-COV-2 infection on ocular surface. Ocul Surf 2020; 18: 360-362
    CrossrefPubMedGoogle Scholar
  • 19 Bostanci Ceran B, Ozates S. Ocular manifestations of coronavirus disease 2019. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1959-1963
    CrossrefPubMedGoogle Scholar
  • 20 Shereen M, Khan S, Kazmi A. et al. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020; 24: 91-98
    CrossrefPubMedGoogle Scholar
  • 21 Bhandari V, Reddy J, Relekar K. et al. Non-invasive assessment of tear film stability with a novel corneal topographer in Indian subjects. Int Ophthalmol 2016; 36: 781-790
    CrossrefPubMedGoogle Scholar
  • 22 Tian L, Qu J, Zhang X. et al. Repeatability and Reproducibility of Noninvasive Keratograph 5M Measurements in Patients with Dry Eye Disease. J Ophthalmol 2016; 2016: 8013621
    CrossrefPubMedGoogle Scholar
  • 23 Kim J, Kim J, Seo K. et al. Location and pattern of non-invasive keratographic tear film break-up according to dry eye disease subtypes. Acta Ophthalmol 2019; 97: e1089
    PubMedGoogle Scholar