Tokyo, Japan) and XR Avanti SD-OCT (Optovue, Fremont, CA, USA).All patients showed hyper-reflective lesions at the level of ganglion cell and inner plexiform layers more prominently at the papillomacular bundle in both eyes (figure). Results of OCT-angiography and ganglionar cells complex analysis appeared normal. Furthermore, four patients presented subtle cotton wool spots and microhaemorrhages along the retinal arcade, observed on fundus examination, color fundus photography, and red-free imaging. Visual acuity and pupillary reflexes were normal in all eyes, and we detected no symptoms or signs of intraocular inflammation.Although animal models suggest ocular lesions could include retinitis and optic neuritis, 3,4 this is, to the best of our knowledge, the first report of retinal findings possibly associated with COVID-19 infection in humans. Ganglion cell and plexiform layer findings could be associated with CNS manifestations that have been described in animal studies 4 and in COVID-19 neurological events. 5 We declare no competing interests.

ARS-CoV-2 is an enveloped positive-sense RNA coronavirus belonging to the Coronaviridae family, and its cellular entry depends mainly on the binding of S protein 1,2 to angiotensin-converting enzyme 2, a specific cellular receptor located at the surface of the host cells. 3,4 The SARS-CoV-2 viral particles' presence in the retina of deceased patients with COVID-19 has been suggested through the real-time polymerase chain reaction (PCR) and immunological methods to detect its main proteins. The eye is affected by COVID-19 infection, 5,6 and retinal changes were attributed to secondary microvascular and immunological changes. The aim of this study was to detect the presence of presumed SARS-CoV-2 viral particles in the retina of individuals who died of COVID-19 using fluorescence microcopy of tissues immunostained for S1 and nucleocapsid proteins and transmission electron microscopy of thin sections. MethodsThis investigational study was approved by the ethical and research committee at the Federal University of São Paulo in São Paulo, Brazil, and all patients' representatives agreed to participate through written consent applied after the patient's death. They were informed of the procedure and potential benefits and risks, and no compensation was received for agreeing to participate. Detailed demographic, medical history, concomitant events, medication history, hospitalization details, IMPORTANCE The presence of the SARS-CoV-2 virus in the retina of deceased patients with COVID-19 has been suggested through real-time reverse polymerase chain reaction and immunological methods to detect its main proteins. The eye has shown abnormalities associated with COVID-19 infection, and retinal changes were presumed to be associated with secondary microvascular and immunological changes.OBJECTIVE To demonstrate the presence of presumed SARS-CoV-2 viral particles and its relevant proteins in the eyes of patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTSThe retina from enucleated eyes of patients with confirmed COVID-19 infection were submitted to immunofluorescence and transmission electron microscopy processing at a hospital in São Paulo, Brazil, from June 23 to July 2, 2020. After obtaining written consent from the patients' families, enucleation was performed in patients deceased with confirmed SARS-CoV-2 infection. All patients were in the intensive care unit, received mechanical ventilation, and had severe pulmonary involvement by COVID-19. MAIN OUTCOMES AND MEASURESPresence of presumed SARS-CoV-2 viral particles by immunofluorescence and transmission electron microscopy processing.RESULTS Three patients who died of COVID-19 were analyzed. Two patients were men, and 1 was a woman. The age at death ranged from 69 to 78 years. Presumed S and N COVID-19 proteins were seen by immunofluorescence microscopy within endothelial cells close to the capillary flame and cells of the inner and the outer nuclear layers. At the perinuclear region of these cells, it was possible to observe by transmission electron microscopy dou...