Li RR, Zhang BM, Rong SR, Li H, Shi PF, Wang YC. Fifteen acute retrobulbar optic neuritis associated with COVID-19: A case report and review of literature. World J Clin Cases 2024; 12(21): 4827-4835 [DOI: 10.12998/wjcc.v12.i21.4827]
Corresponding Author of This Article
Yun-Chang Wang, MD, Doctor, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, No. 399 East Quanbei Street, Xingtai 054001, Hebei Province, China. wycocular@163.com
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rong-Rong Li, Bao-Ming Zhang, Su-Ran Rong, Huan Li, Peng-Fei Shi, Yun-Chang Wang, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
Author contributions: Wang YC designed and conceptualized the research proposal; Zhang BM analyzed the data; Li RR wrote the paper; Li H, Shi PF and Rong SR collected the data and information; All authors gave their approval of the final manuscript after reviewing it.
Supported byMunicipal Science and Technology Plan Project of Xingtai City, Hebei Province, No. 2022ZC232 and No. 2022ZC129.
Informed consent statement: This study was approved by the Medical Ethics Committee of Hebei Eye Hospital. Before beginning the study, all enrolled patients gave their informed consent to participate, according to the Declaration of Helsinki.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Chang Wang, MD, Doctor, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, No. 399 East Quanbei Street, Xingtai 054001, Hebei Province, China. wycocular@163.com
Received: April 15, 2024 Revised: May 21, 2024 Accepted: June 11, 2024 Published online: July 26, 2024 Processing time: 76 Days and 10.4 Hours
Abstract
BACKGROUND
A subtype of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is suggested to be responsible for the outbreak in Northern China since the quarantine was lifted in December 2022. The coronavirus disease 2019 virus is primarily responsible for the development of respiratory illnesses, however, it can present a plethora of symptoms affecting a myriad of body organs. This virus has been theorized to be linked to demyelinating lesions of the peripheral and central nervous system including transverse myelitis and acute retrobulbar optic neuritis (ARON). For example, magnetic resonance imaging (MRI) of the orbit and brain showed enlargement of the retrobulbar intraorbital segments of the optic nerve with high T2 signal, and no abnormalities were seen in the brain tissue. In this case series, we analyzed the connection between SARS-CoV-2 infection and the onset of ARON.
CASE SUMMARY
Fifteen patients, and a teenage boy who did not have any pre-existing ocular or demyelinating diseases suddenly experienced a loss of vision after SARS-CoV-2 infection. The patients expressed a central scotoma and a fever as the primary concern. The results of the fundus photography were found to be normal. However, the automated perimetry and MRI scans showed evidence of some typical signs. Out of the 15 patients diagnosed with ARON after SARS-CoV-2 infection, only one individual tested positive for the aquaporin-4 antibody.
CONCLUSION
Direct viral invasion of the central nervous system and an immune-related process are the two primary causes of SARS-CoV-2-related ARON.
Core Tip: Our study is the first to elucidate the relationship between the Omicron variant of severe acute respiratory syndrome coronavirus 2 and acute retrobulbar optic neuritis in China, which may be attributed to two main factors: Immune involvement in the process and direct viral infiltration of the central nervous system. In addition, hypoxia and ischemia may be associated with the appearance of this disease. Further investigation is needed to gain a more complete picture of this relationship.
