Introduction
The pandemic of COVID-19 has been caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Apart from respiratory malfunction, COVID-19 causes a system-wide thromboembolic state, leading to serious cardiovascular, cerebrovascular and peripheral vascular manifestations. However, our knowledge regarding retinal manifestations due to systemic COVID-19 is minimal. This systematic review has comprehensively summarized all retinal manifestations secondary to COVID-19 disease recorded till date since the beginning of the pandemic.
Methods
All studies published till November 27, 2020, which have reported retinal manifestations in COVID-19 patients were systematically reviewed using the PRISMA statement.
Results
We included 15 articles: 11 case reports and four cross-sectional case series. The most commonly reported manifestations which did not affect visual acuity were retinal hemorrhages and cotton wool spots. The most common vision threatening manifestation was retinal vein occlusion with associated macular edema. Rarely, patients may also present with retinal arterial occlusions and ocular inflammation. These manifestations may occur from as soon as within a week after the onset of COVID-19 symptoms to more than 6 weeks after.
Conclusion
Mostly causing milder disease, COVID-19 may however lead to severe life-threatening thromboembolic complications, and systemic antithrombotic therapy has been suggested as a prophylactic and therapeutic management strategy for patients affected with serious systemic disease. However, both sick and apparently healthy patients may suffer from various retinal complications which may lead to loss of vision as well. No consensus regarding management of retinal complications with anticoagulants or anti-inflammatory medications have been proposed; however, they may be tackled on individual basis.
Background:Physicians have long recognized the association between diabetes mellitus and several pathologic conditions of the hand. The most commonly recognized maladies are limited joint mobility (LJM), Dupuytren's disease (DD), trigger finger (TF), and carpal tunnel syndrome (CTS). Incidence of these hand disorders has increased in the setting of diabetes. Collectively, these are described as diabetic hand syndrome.Aim:The aims were to find out the prevalence of hand disorders in diabetic patients, and to study the relation of these hand disorders with microvascular complications.Subjects and Methods:This is an observational cross-sectional case-control study done over a period of 1 year Patients of type 2 DM, of age < 65 years, who visited Gandhi Memorial Hospital, Lucknow were enrolled and were described as cases. Age- and sex-matched nondiabetic individuals were taken in the control group. The data were analyzed using software SPSS. SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Means and standard deviations were computed; the Student t-test and Chi-square (χ2) test were used as appropriate.Results:A total of 400 subjects were studied, 200 each in the case and control groups. Of total 200 diabetic patients, 30% (60/200) patients had neuropathy, 37.5% (75/200) had nephropathy, and 44.5% (89/200) patients had retinopathy. In the study population, 67% patients were having one or more hand disorders, in which LJM was found in 40.5% (81/200) patients, DD was found in 19% (38/200) patients, TF in 16.5% (33/200), and CTS in 14% (28/200) patients.Conclusions:This study shows a high prevalence of hand disorders in diabetic patients and also correlates with the duration of type 2 DM, LJM being the most common hand disorder and more common in patients who have microvascular complications.
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