The value of subepithelial corneal infiltrates and pseudomembranes as robust indicators of adenoviral conjunctivitis

González-Martín-Moro, J.; Guzmán-Almagro, E.; Izquierdo Rodríguez, C.; Fernández Hortelano, A.

doi:10.1016/j.oftale.2022.01.003

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González-Martín-Moro, E. Guzmán-Almagro, C. Izquierdo Rodríguez, A. Fernández Hortelano" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "González-Martín-Moro" "email" => array:2 [ 0 => "juliogmm@yahoo.es" 1 => "juliogazpeitia@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Guzmán-Almagro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Izquierdo Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Fernández Hortelano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El valor de los infiltrados corneales subepiteliales y las pseudomembranas como indicadores robustos de conjuntivitis adenovírica" ] ] "textoCompleto" => "We have read the article entitled “Pandemic COVID-19: impact on the rate of adenoviral conjunctivitis”<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and would like to share our experience on the subject, as we have recently published an article analysing the same phenomenon.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The design of our study is similar: it is also a historical cohort study, comparing a six-month COVID period with the equivalent period of the previous year.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Our study comprises a smaller number of patients with viral conjunctivitis but, as it was conducted in a primary hospital, we believe that our data are less affected by some biases that might limit a patient’s attendance at a tertiary hospital during such a critical period.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In our study the pathologies were grouped into clusters and the cluster of conjunctival pathology featured the most evident decrease (65% reduction) of the 14 studied. Adenoviral conjunctivitis had a reduction of almost 90%, and was the diagnosis with the largest decrease of the 108 diagnoses studied.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>However, both the study by Conde Bachiller et al. and ours have two important limitations. The first is that the diagnosis was clinical, without microbiological confirmation in both cases, and the second is that it can always be argued that the decline is not real but due to reduced patient access to health care as a result of the limitations and fear imposed by the pandemic.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>To overcome this limitation, we also collected the number of visits for complications of viral conjunctivitis (membranes and subepithelial corneal infiltrates). We reviewed the number of patients diagnosed with conjunctivitis regardless of etiology who subsequently developed these complications, as well as the number of patients with these complications seen in the Emergencies Dept. during the period studied. These complications are relatively specific to adenoviral conjunctivitis and are much more robust indicators of this etiology, as the severe pain and visual loss it associates usually forces the patient to seek medical attention and more specifically ophthalmological care.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Both of these complications decreased markedly. The number of patients who developed membranes decreased from 16 in the pre-COVID period to four in the COVID period, and it is noteworthy that three of the four cases are complications of adenoviral conjunctivitis transmitted in the pre-COVID period, as they were seen during the early days of the pandemic (March and April 2020). A similar pattern of reduction was seen in infiltrates, which were reduced from nine to three, with two of the three cases diagnosed in the COVID period being seen during the first two months of the pandemic.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In summary, we believe that because our study was made in a primary hospital it supplements that of Conde Bachiller et al., and that the analysis of complications reinforces the idea that the reduction in adenoviral conjunctivitis is real.Conflict of interestNone of the authors have any commercial interest in relation to this letter. This article has not been submitted to any other journal." 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Arch Soc Esp Oftalmol. 2022;97:539–540." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pandemia COVID-19: impacto sobre la tasa de conjuntivitis virales [COVID-19 pandemic: impact on the rate of viral conjunctivitis.]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.C. Bachiller" 1 => "B.P. Gete" 2 => "L.G. Ibáñez" 3 => "G.E. Benito" 4 => "M.A. Duran" 5 => "J.V. Dabad Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftale.2022.01.001" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2021" "volumen" => "97" "paginaInicial" => "63" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35152950" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of the COVID-19 lockdown on ophthalmological assistance in the emergency department at a Spanish primary level hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. González-Martín-Moro" 1 => "E. Guzmán-Almagro" 2 => "C. Izquierdo Rodríguez" 3 => "A. Fernández Hortelano" 4 => "I. Lozano Escobar" 5 => "F. Gómez Sanz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Ophthalmol" "fecha" => "2021" "volumen" => "2021" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009700000009/v1_202209010606/S2173579422000780/v1_202209010606/en/main.assets" "Apartado" => array:4 [ "identificador" => "5813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009700000009/v1_202209010606/S2173579422000780/v1_202209010606/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422000780?idApp=UINPBA00004N"]

ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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