Central retinal vein occlusion secondary to varicella zoster retinal vasculitis in an immunocompetent individual during the COVID-19 pandemic - A case report

The Varicella-zoster virus (VZV) or human herpes virus 3 is a neurotropic human alpha herpes virus responsible for chickenpox/varicella and shingles/herpes zoster (HZ). This review will focus on HZ. Since HZ is secondary to varicella, its incidence increases with age. In children and youngsters, HZ is rare and associated to metabolic and neoplastic disorders. In adults, advanced age, distress, other infections (such as AIDS or COVID-19), and immunosuppression are the most common risk factors. HZ reactivation has recently been observed after COVID-19 vaccination. The disease shows different clinical stages of variable clinical manifestations. Some of the manifestations bear a higher risk of complications. Among the possible complications, postherpetic neuralgia, a chronic pain disease, is one of the most frequent. HZ vasculitis is associated with morbidity and mortality. Renal and gastrointestinal complications have been reported. The cornerstone of treatment is early intervention with acyclovir or brivudine. Second-line treatments are available. Pain management is essential. For (secondary) prophylaxis, currently two HZV vaccines are available for healthy older adults, a live attenuated VZV vaccine and a recombinant adjuvanted VZV glycoprotein E subunit vaccine. The latter allows vaccination also in severely immunosuppressed patients. This review focuses on manifestations of HZ and its management. Although several articles have been published on HZ, the literature continues to evolve, especially in regard to patients with comorbidities and immunocompromised patients. VZV reactivation has also emerged as an important point of discussion during the COVID-19 pandemic, especially after vaccination. The objective of this review is to discuss current updates related to clinical presentations, complications, and management of HZ.

show abstract

“…CNS arteritis has been mentioned above. Retinal vasculitis is a severe, but rare complication of HZO treated by antiviral medication [62].…”

Section: Vasculitismentioning

confidence: 99%

Herpes zoster: A Review of Clinical Manifestations and Management

Patil

Goldust

Wollina

2022

Viruses

219

123

View full text Add to dashboard Cite

show abstract

“…Other authors proposed that retinal vasculitis may be involved in retinal vein occlusion. Sarpangala S et al reported a case of CRVO possibly secondary to retinal vasculitis [ 49 ]. Vasculitis following immunisation has been observed for other types of vaccines [ 50 , 51 ], although the causal link is unclear [ 51 ].…”

Section: Proposed Mechanisms Of Suspected Vaccine-related Rvomentioning

confidence: 99%

Retinal Vein Occlusion after COVID-19 Vaccination—A Review

Leung

2023

Vaccines

View full text Add to dashboard Cite

Background Retinal vein occlusion (RVO) occurring after COVID-19 vaccination has been reported worldwide. Such a sight-threatening condition occurring after COVID-19 vaccination is a menace to ophthalmic health. This article reviews current evidence related to post-COVID-19 vaccination RVO. Method A total of 29 relevant articles identified on PubMed in January 2023 were selected for review. Observation All cases presented to ophthalmologists with visual loss shortly after COVID-19 vaccination. Mean and median age were both 58. No sex predominance was observed. RVO was diagnosed from findings on dilated fundal examination and ophthalmic imaging. AstraZeneca and BNT vaccines accounted for most cases. Vascular risk factors, e.g., diabetes mellitus and hypertension, were common. Most laboratory tests requested came back unremarkable. Most patients responded well to standard treatment, except those with ophthalmic comorbidities. Visual prognosis was excellent on short-term follow-up. Discussion The causality between RVO and COVID-19 vaccination is undeterminable because of the nature of articles, heterogenous reporting styles, contradicting laboratory findings and co-existing vascular risk factors. Vaccine-induced immune thrombotic thrombocytopenia, retinal vasculitis and homocysteinaemia were proposed to explain post-vaccination RVO. Large-scale studies have demonstrated that the incidence of RVO following COVID vaccination is very low. Nevertheless, the effects of boosters on retinal vasculature and ophthalmic health are still unclear. Conclusions The benefits of COVID-19 vaccination are believed to outweigh its ophthalmic risks. To ensure safe vaccination, the prior optimisation of comorbidities and post-vaccination monitoring are important. COVID-19 vaccines (including boosters) should be offered with reasonable confidence. Further studies are warranted to elucidate the ophthalmic impact of vaccines.

show abstract

“… [1] Its typical clinical manifestation is sudden painless monocular vision loss. [2] In 1878, von Michel believed that the cause of the disease was venous embolism. At present, CRVO has become one of the main causes of blindness, [3] which negatively affects the quality of life, increases the psychological burden and financial burden.…”

Section: Introductionmentioning

confidence: 99%

“…Central retinal vein occlusion (CRVO), also known as retinal apoplexy, is one of the common clinical retinal vascular diseases [1] . Its typical clinical manifestation is sudden painless monocular vision loss [2] . In 1878, von Michel believed that the cause of the disease was venous embolism.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of antivascular endothelial growth factors for central retinal vein occlusion

Liu

Wang

et al. 2021

Medicine

View full text Add to dashboard Cite

Background: Central retinal vein occlusion (CRVO) is one of the most common retinal vascular diseases, which is closely related to systemic diseases like hypertension, diabetes and arteriosclerosis. Due of its blinding, it will seriously reduce the quality of life. Macular edema (ME) caused by CRVO is one of the serious complications of visual impairment. We found that the severity of ME in CRVO was positively associated with vascular endothelial growth factor (VEGF) in the anterior chamber. With the accelerated pace of modern life and the changed dietary structure, the incidence of this disease will continue to rise. Therefore, it is of great practical significance to seek effective treatment methods. Intraocular injection of anti-VEGF can effectively alleviate ME and improve visual acuity, showing excellent clinical application prospects. In recent years, there have been some new understandings and advances on the etiology and treatment methods of the present disease, such as the deepening into the molecular biology and gene level. Clinical studies on the efficacy of the disease have emerging. Therefore, a network meta-analysis (NMA) of anti-VEGF treatment for CRVO is particularly necessary to systematically compare its efficacy. Methods: The two reviewers will comprehensively retrieved electronic databases such as PubMed, The Cochrane Library, Wanfang database, Web of Science, Chinese Scientifific Journals Database, EMBASE, China National Knowledge Infrastructure, and China BioMedical Literature. A randomized controlled trial for CRVO against VEGF between January 2010 and June 2021 was included according to the relevant content of the study. In addition, 2 researchers will screen the literature to assess the risk bias for the included articles. We will evaluate the collected evidence and data using a Bayesian NMA method, and analyzed it with STATA and WinBUGS software. Results: Anti-VEGF is one of the effective methods for ME in CRVO patients, accordingly, this study will evaluate its efficacy and safety using a Bayesian NMA system. Conclusion: This study can provide an effective rationale for the clinical application of anti-VEGF for CRVO, contribute to the treatment of CRVO and patient condition rehabilitation in clinical work. Ethics and dissemination: Do not require. INPLASY registration number: INPLASY2021110073.

show abstract

Central retinal vein occlusion secondary to varicella zoster retinal vasculitis in an immunocompetent individual during the COVID-19 pandemic - A case report

Cited by 11 publications

References 12 publications

Herpes zoster: A Review of Clinical Manifestations and Management

Herpes zoster: A Review of Clinical Manifestations and Management

Retinal Vein Occlusion after COVID-19 Vaccination—A Review

Comparative efficacy and safety of antivascular endothelial growth factors for central retinal vein occlusion

Contact Info

Product

Resources

About