Possible Retinal Impairment Secondary to Ritonavir Use in SARS-CoV-2 Patients: A Narrative Systematic Review

Cozzupoli, Grazia Maria; Savastano, Maria Cristina; Falsini, Benedetto; Savastano, Alfonso; Rizzo, Stanislao

doi:10.1155/2020/5350494

Cited by 9 publications

(8 citation statements)

References 32 publications

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“…Lopinavir and ritonavir, protease inhibitor agents which have controversial treatment effects on COVID-19, may cause reactivation of autoimmune conditions. Due to the retinal toxicity of ritonavir, it has been hypothesized that simultaneous use of it with chloroquine/hydroxychloroquine can lead to a synergic toxic effect on the retina [ 70 , 71 ]. Ribavirin, another antiviral agent, has not been used much for COVID-19 but can cause major ophthalmologic complications such as retinopathy, retinal vein occlusion, and serous retinal detachment [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research

Forouhari

Mansouri

Safi

et al. 2022

Journal of Ophthalmology

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This review is proposed to summarize the updates on COVID-19 and ophthalmology along with the bibliometric features of articles that have been published since the beginning of the COVID-19 outbreak. The databases, including PubMed, Scopus, and Web of Science, were searched using “Coronavirus,” “COVID-19,” “SARS-CoV-2,” “pandemic,” “ophthalmology,” “ophthalmic,” and “eye” keywords. All published articles except commentaries, errata, and corrigenda up to April 2021 were included. Titles and abstracts were screened, and ophthalmology-focused articles were collected. The bibliographic information of the articles, such as the name and country of the first author, type of study, date of publication, language, and journal name, were extracted. Included studies were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. After systematic searching, 2,669 distinct articles were screened by title/abstract, and 1,174 ophthalmology-focused articles were selected to be reviewed. Ophthalmology-focused publications accounted for less than 0.5 percent of the total COVID-19-related articles. Most of the articles were published in the Indian Journal of Ophthalmology, and the main publication type was “original article.” Almost 88% of the publications were in English. There was a decline in the publication rate during the initial months of 2021 compared with the middle and last months of 2020. Most of the publications were affiliated with the United States of America. However, Singapore and the United Kingdom were the countries with the highest number of publications after population adjustment. Furthermore, a comprehensive review on major topics including SARS-CoV-2 ocular tropism, ophthalmic manifestations, ocular complications due to COVID-19 treatment strategies, the pandemic effect on ophthalmology care and operations, myopia progression during the pandemic, and telemedicine was conducted.

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Section: Resultsmentioning

confidence: 99%

A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research

Forouhari

Mansouri

Safi

et al. 2022

Journal of Ophthalmology

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“…Original article preauricular lymph nodes, and watery discharge were found to be common ocular findings in patients with active COVID-19 [5][6][7]. To the best of our knowledge, there are few studies about the possible effects of SARS-Cov-2 virus infection on the posterior segment of the eye, in the literature [8][9][10]. The hypothesis of this current study is the effect of possible microvascular changes and neuroinflammation on inner retinal layers.…”

Section: Experimental Biomedical Researchmentioning

confidence: 91%

The effect of COVID-19 infection on retinal nerve fiber layer and ganglion cell complex layer thicknesses

Özmen¹,

Çakır²,

Okan³

et al. 2021

j-ebr

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To evaluate the possible effects of SARS-CoV-2 infection on retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GC-IPL) thicknesses. Method: Patients who had been infected by SARS-CoV-2 and hospitalized because of severe pneumonia were found out from the database of COVID-19 pandemic hospital and formed the patient group. The control group was composed of non-COVID-19 age-matched subjects. The mean and fragmented RNFL and GC-IPL thicknesses were measured by optical coherence tomography (OCT), and compared between two groups, statistically. Results: Patient group 34 eyes of 34 subjects (18 male, 16 female) and 31 eyes of 31 subjects (14 male, 17 female) in the control group were enrolled. The mean age and gender were not statistically different between groups (p:0.56, 0,57, respectively).A statistically significant difference was not found between groups in terms of mean, superior, inferior, temporal, nasal RNFL thicknesses and mean superior, inferior, temporal, and nasal GC-IPL thicknesses. Conclusion:The mean and fragmented RNFL and GC-IPL thicknesses measured by OCT were not statistically different in patients who had moderate disease course and recovered from COVID-19 infection.

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“…However, ritonavir used as an inhibitor of HIV-1 protease prevents the cleavage process of viral polyprotein precursors into mature and functional proteins, hence interrupting the production of new viral particles [ 24 , 30 ]. The common side effects of ritonavir are nausea, vomiting, diarrhea, changes in taste, fatigue, rash, and—associated with long-term use—hyperlipidemia and lipodystrophy [ 30 , 31 ]. Ritonavir was used to boost the effect of other antiviral drugs based on its inhibition of cytochrome P450-3A4 (CYP450-3A4) and, to a lesser extent, cytochrome P450-2D6 (CYP450-2D6) [ 30 ].…”

Section: Pharmacokinetic Properties and Safety Concerns Of Paxlovid™ ...mentioning

confidence: 99%

Oral Nirmatrelvir/Ritonavir Therapy for COVID-19: The Dawn in the Dark?

et al. 2022

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Nirmatrelvir/ritonavir (Paxlovid™) is an effective and safe antiviral drug that inhibits the main protease (Mpro), 3CL protease, of SARS-CoV-2. A reduction in COVID-19-related hospitalization or death was observed in patients treated with nirmatrelvir/ritonavir within five days of symptom onset. Moreover, good oral availability enables the usage of nirmatrelvir/ritonavir, not only in hospitalized patients, but also among outpatients. Nirmatrelvir (PF-07321332) has been demonstrated to stop the spread of COVID-19 in animal models. Despite frequent mutations in the viral genomes of SARS-CoV-2, nirmatrelvir shows an effective antiviral effect against recent coronavirus mutants. Despite the promising antiviral effect of nirmatrelvir, there are several unresolved concerns. First, the final results of large-scale clinical trials for early therapy of mild cases of COVID-19 are not yet published. Second, the effectiveness of nirmatrelvir against upcoming variants in the coming years requires close monitoring. Considering the promising preliminary results of the EPIC-HR trial, nirmatrelvir/ritonavir in conjunction with vaccines and non-pharmacological interventions, may represent the dawn in the dark of the COVID-19 pandemic.

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Possible Retinal Impairment Secondary to Ritonavir Use in SARS-CoV-2 Patients: A Narrative Systematic Review

Cited by 9 publications

References 32 publications

A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research

A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research

The effect of COVID-19 infection on retinal nerve fiber layer and ganglion cell complex layer thicknesses

Oral Nirmatrelvir/Ritonavir Therapy for COVID-19: The Dawn in the Dark?

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