Evaluation of Macular Retinal Vessels and Histological Changes in Two Cases of COVID-19

Hernández, María; González-Zamora, Jorge; Recalde, Sergio; Moreno-Orduña, Maite; Bilbao-Malavé, Valentina; Viteri, Manuel Sáenz de; Landecho, Manuel F.; Fernández-Robredo, Patricia; García‐Layana, Alfredo

doi:10.3390/biomedicines9111546

Cited by 5 publications

(5 citation statements)

References 37 publications

(43 reference statements)

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“…In that study D-Dimer plasma level ranged between 717 and 5536 ng/ml. An inverse correlation between plasma level of D-Dimer and microcirculatory changes was found also in the retinal vessels of severe COVID-19 infected patients (172,173).This indicates once more that the changes observed in the alveolar capillaries and those observed in other territories (174) may be attributale to the same noxae, namely dehydration conditioning tissue oxygenation followed by the emergency induction of the perivasal clotting process.…”

Section: Fig4 Ct-scan Oft He Cest Of Patients With Ards Of Different ...mentioning

confidence: 63%

SARS-CoV-2-Infection (COVID-19): Clinical Course and Cause(s) of Death

Ramadori¹

2022

Preprint

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Two years after first patients approached the emergency rooms of hospitals in Wuhan becouse of respiratory distress,thousend of SARS-CoV-2 infected persons continue to die every day worldwide.SARS-CoV-2-infected patients undergo a process of dehydration and malnutrition before they develop respiratory problems and approach the emergency room of a hospital.This is,in many cases, the consequence of high fever which causes massive loss of fluids. In addition loss of appetite, is responsible for the deficit of protein intake.Most of the virus-infected patients admitted to the emergency room are therefore hypovolemic and hypoproteinemic and suffer of respiratory distress accompanied by ground grass opacities at CT-scan of the lungs.Critically ill patients are treated following the guidelines for treatment of septic shock but with &bdquo;conservative“ fluid replacement and administration of diuretics to assure sufficient hourly urine production. The combination of conservative fluid administration with reduced protein content in the enterally administered diet, together with administration of diuretics, has severe hemodynamic consequenses in mostly aged,dehydrated,critically ill patients. Many of them will develop acute kidney injury in the next 24 hours.In most of the cases, patients continue to loose weight by loosing skeletal muscle mass. Ischemic damage in the lung capillaries is responsible for the acute respiratory distreass syndrome (ARDS) and for the hallmark of autoptic findings,diffuse alveolar damage (DAD) characterized by hyaline membrane formation,fluid invasion of the alveoli recruitment of some inflammatory cells and progressive arrest of blood flow in the pulmonary vessels.The consequence is progressive congestion , increase of lung weight and progressive hypoxia (progressive severity of ARDS).Sequestration of blood in the lungs worsen hypovolemia and ischemia in different organs.This is most probably responsible for recruitment of inflammatory cells and for persistance of elevated serum levels of positive acute-phase markers and of hypoalbuminemia. Autoptic studies have been performed mostly in patients who died in the ICU after SARS-CoV-2-infection because of progessive ARDS.In those patients, tubulus epithelium necrosis in the kidney is a frequent finding as it has been the case in the first SARS-CoV-1 pandemic.In the death certification charts, many times weeks after first symptoms have started ,cardiac arrest is the cause of death after respitatory insufficiency.Replacement therapy with sufficient amount of fluid and albumin should be part of the early individualized life-saving supportive measures avoiding mechanical ventilation.

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Section: Fig4 Ct-scan Oft He Cest Of Patients With Ards Of Different ...mentioning

confidence: 63%

SARS-CoV-2-Infection (COVID-19): Clinical Course and Cause(s) of Death

Ramadori¹

2022

Preprint

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“…5 COVID-19 is known to cause a pro-inflammatory cascade resulting in vascular alteration. 6 Therefore, the currently theorized etiology suggests that the hypercoagulable state and vasculitis caused by COVID-19 create microthrombosis leading to an increased incidence of AMN further supporting the theorized microvascular etiology of AMN. 2,7 Visual evoked potential (VEP) was used to primarily evaluate the visual pathway from the optic nerve to the occipital lobe.…”

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

“…5 COVID-19 is known to cause an inflammatory response and vascular alteration. 6 Therefore, the currently theorized etiology suggests that the hypercoagulable state and vasculitis caused by COVID-19 create microthrombosis leading to an increased incidence of AMN. 2,7 This case series details two cases of presumed unilateral and bilateral AMN in patients with mild COVID-19 infection and our observations.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Related Acute Macular Neuroretinopathy (AMN): A Case Series

Vu,

Schillerstrom,

Mancha

et al. 2023

IMCRJ

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Purpose Following the emergence of coronavirus disease 2019 (COVID-19) eye care practitioners have become accustomed to identifying and managing an array of ocular complications following the viral infection. Acute macular neuroretinopathy (AMN) is one such complication that has been reported. While the etiology of AMN has eluded researchers, current literature is suggestive of a microvascular compromise within the deep capillary plexus of the retina. Observations In this case series, we aim to explore two individual cases of presumed AMN following confirmed COVID-19 infection. Our observations and findings support the diagnosis of AMN following the criteria outlined in literature. Conclusion and Importance Although acute macular neuroretinopathy is rare, it should be considered by clinicians when considering diagnosis. With the changing landscape of the pandemic, careful and thorough history and testing are key in the diagnosis of AMN.

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“…An inverse correlation between the plasma level of the D-Dimer and microcirculatory changes was found also in the retinal vessels of severe COVID-19-infected patients [ 190 , 191 ]. This indicates once more that the changes observed in the alveolar capillaries and those observed in other territories [ 191 ] may be attributable to the same noxae, namely dehydration conditioning tissue oxygenation followed by the emergency induction of the perivasal clotting process.…”

Section: How Sars-cov-2 Infection Of the Nose Leads To Ards Cardiac A...mentioning

confidence: 99%

SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death

Ramadori

2022

Medical Sciences

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SARS-CoV-2-infected symptomatic patients often suffer from high fever and loss of appetite which are responsible for the deficit of fluids and of protein intake. Many patients admitted to the emergency room are, therefore, hypovolemic and hypoproteinemic and often suffer from respiratory distress accompanied by ground glass opacities in the CT scan of the lungs. Ischemic damage in the lung capillaries is responsible for the microscopic hallmark, diffuse alveolar damage (DAD) characterized by hyaline membrane formation, fluid invasion of the alveoli, and progressive arrest of blood flow in the pulmonary vessels. The consequences are progressive congestion, increase in lung weight, and progressive hypoxia (progressive severity of ARDS). Sequestration of blood in the lungs worsens hypovolemia and ischemia in different organs. This is most probably responsible for the recruitment of inflammatory cells into the ischemic peripheral tissues, the release of acute-phase mediators, and for the persistence of elevated serum levels of positive acute-phase markers and of hypoalbuminemia. Autopsy studies have been performed mostly in patients who died in the ICU after SARS-CoV-2 infection because of progressive acute respiratory distress syndrome (ARDS). In the death certification charts, after respiratory insufficiency, hypovolemic heart failure should be mentioned as the main cause of death.

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Evaluation of Macular Retinal Vessels and Histological Changes in Two Cases of COVID-19

Cited by 5 publications

References 37 publications

SARS-CoV-2-Infection (COVID-19): Clinical Course and Cause(s) of Death

SARS-CoV-2-Infection (COVID-19): Clinical Course and Cause(s) of Death

COVID-19 Related Acute Macular Neuroretinopathy (AMN): A Case Series

SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death

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