The Outbreak of Acute Primary Angle-Closure Cases During the COVID-19 Omicron Variant Pandemic at a Tertiary Eye Center in Shanghai

Figures & data

Table 1 Demographic Characteristics of Patients with APAC in Both Groups

Characteristics	Control Group November 15, 2021–February 14, 2022	Pandemic Group December 15, 2022–January 14, 2023	p value
Patients, n	75	223
Eyes, n	82	261
Mean age (mean ± SD), years	67.05 ± 8.95	65.34 ± 8.13	0.124
Gender, n (%)			0.418^a
Male	16 (21.33)	58 (26.01)
Female	59 (78.67)	165 (73.99)
Affected eyes, n (%)			0.107^a
Bilateral	7 (9.33)	38 (17.04)
Single	68 (90.67)	185 (82.96)
Eyes, n (%)			0.205^a
Left	43 (52.44)	116 (44.44)
Right	39 (47.56)	145 (55.56)
COVID-19 infection history, n (%)	0	162 (72.65)	<0.001^b

Notes: All data were showed as mean ±SD. ^aChi-squared test. ^bFisher’s exact test.

Abbreviation: SD, standard deviation.

Figure 1 The onset date of patients with APAC recruited in the same period of different years with or without COVID-19 pandemic.

Table 2 Ocular Biometry of Patients with APAC in Both Groups

Characteristics	Control Group November 15, 2021–February 14, 2022	Pandemic Group December 15, 2022–January 14, 2023	Unadjusted p value	B/H-Adjusted p value
Time from symptoms to treatment, days	3.63 ± 2.93	7.92 ± 6.14	<0.001	0.006*
Peak IOP, mmHg	48.25 ± 7.23	46.01 ± 8.20	0.061	0.122
AL, mm	22.36 ± 0.71	22.63 ± 2.28	0.340	0.408
ACD, mm	1.58 ± 0.29	1.62 ± 0.24	0.172	0.258
LT, mm	4.99 ± 0.44	5.02 ± 0.32	0.475	0.475
Pupil diameter, mm	3.78 ± 1.24	4.53 ± 1.17	<0.001	0.003*

Notes: *B/H-adjusted p < 0.05 indicates statistical significance.

Abbreviations: AL, axial length; ACD, anterior chamber depth; LT, lens thickness; IOP, intraocular pressure.

Table 3 Demographic Characteristics of Patients with APAC in the Pandemic Group

Characteristics	COVID-19-Positive	COVID-19-Negative	p value
Patients, n	162	61
Eyes, n	192	69
Mean age (mean ± SD), years	65.25 ± 8.26	65.57 ± 7.83	0.790
Gender, n (%)			0.157^a
Male	38 (23.46)	20 (32.79)
Female	124 (76.54)	41 (67.21)
Affected eyes, n (%)			0.586^a
Bilateral	30 (18.52)	8 (13.11)
Single	132 (81.48)	53 (86.89)
Eyes, n (%)			0.706^a
Left	84 (43.75)	32 (46.38)
Right	108 (56.25)	37 (53.62)

Note: ^aChi-squared test.

Table 4 Ocular Biometry of Patients with APAC in the Pandemic Group

Characteristics	COVID-19-Positive	COVID-19-Negative	Unadjusted p value	B/H-Adjusted p value
Time from symptoms to treatment, days	8.42 ± 6.21	6.55 ± 5.76	0.03	0.090
Peak IOP, mmHg	45.97 ± 8.08	46.10 ± 8.55	0.923	0.923
AL, mm	22.69 ± 2.58	22.41 ± 0.85	0.431	0.647
ACD, mm	1.60 ± 0.25	1.63 ± 0.23	0.359	0.647
LT, mm	5.02 ± 0.32	5.04 ± 0.33	0.606	0.727
Pupil diameter, mm	4.64 ± 1.19	4.19 ± 1.05	0.008	0.048*

Notes: *B/H-adjusted p < 0.05 indicates statistical significance.

Abbreviations: AL, axial length; ACD, anterior chamber depth; LT, lens thickness; IOP: intraocular pressure.

Figure 2 The days of APAC onset after COVID-19 related systemic symptoms in the COVID-19 positive patients.

Figure 3 A 67-year-old woman with APAC attack after COVID-19 inflection. (A and B): Slit lamp images showed apparent conjunctival hyperemia, corneal epithelial and stromal edema, enlarged pupil, and shallow anterior chamber in left eye. (C): Ultrasound biomicroscopy image showed iris trabecular contact, closed angle, and shallow anterior chamber.

Figure 4 A 59-year-old woman presented to our clinic with complaints of reduced visual acuity, ocular pain, nausea, and vomiting in both eyes one day after COVID-19 inflection. (A and B): Slit lamp images showed obvious conjunctival hyperemia and hemorrhage, corneal epithelial and stromal edema, enlarged pupil, and shallow anterior chamber in right eye. (C): Ultrasound biomicroscopy images showed iris trabecular contact, closed angle, and shallow anterior chamber in the same eye. (D–F): The patient experienced the same APAC attack in the left eye simultaneously.