Fundus evaluation in COVID-19 positives with non-severe disease

Abstract

Purpose: The aim of this work was to study and document retinal changes in coronavirus disease-2019 (COVID-19) positive patients with nonsevere disease using a nonmydriatic handheld fundus camera. Methods: A cross-sectional observational study was conducted on patients affected by COVID-19 who were admitted at our center. Our study included patients with no, mild, and moderate symptoms (nonsevere cases). Intensive care unit (ICU)-admitted patients were excluded considering the difficulty in procuring the fundus image by the handheld camera due to patients positioning. Patients with systemic conditions (diabetes, hypertension, and severe anemia) known to cause retinopathy were also excluded. Bedside anterior segment examination, fundus examination using indirect ophthalmoscopy and fundus imaging of each patient using a nonmydriatic handheld fundus camera was done by a trained ophthalmologist posted for COVID duty. Results: In a cohort of 138 patients, 94 (68.1%) were men and 44 (31.9%) were women. A total of 276 eyes were evaluated. The mean age of the patients was 38.51 ± 14.4 years. Anterior segment evaluation showed no abnormality in any of the eyes. On fundus screening using nonmydriatic handheld camera, a single streak of superficial retinal hemorrhage was noted at the posterior pole of the fundus in the left eye of one patient (0.72%), which was away from fovea. Laboratory tests revealed low hemoglobin (between 10 and 10.9 g/dL falling under mild Anemia) in 12 patients, elevated total leucocyte count in 6 patients, raised LDH in majority of patients (323 ± 101 Units/L) and elevated CRP (14.6 ± 30.99 mg/L). Rest of the lab parameters were within the normal range. Conclusion: In our study, COVID patients with mild-to-moderate symptoms did not show any inflammatory/infective or vaso-occlusive lesions in the retina attributable to COVID-19 infection, except one patient who had a single streak hemorrhage in the macula away from fovea, probably incidental.

The Impact of COVID-19 Infection on Macular Capillary Perfusion

“…Since none of the participants in the study or control groups had any systemic diseases, this was foreseeable. Bypareddy et al ( 10 ) also reported the lack of any fundus pathologies in non-severe COVID-19 patients, except for a single streak of retinal hemorrhage in one eye. Costa et al ( 9 ) reported the frequency of diabetic retinopathy as 52.7%.…”

The prone position in COVID-19 impacts the thickness of peripapillary retinal nerve fiber layers and macular ganglion cell layers

“…Finally, Lani-Louzada et al [ 41 ] studied 25 COVID-19 patients and found retinal hemorrhages in 12%. However, research by Pareddy et al [ 42 ] conducted 6 days after the onset of COVID-19 in a large cohort found nothing except one streak hemorrhage in a single patient. Moreover, retinal hemorrhages, particularly splinter hemorrhages, and tortuous retinal veins can be detected in cases of venous stasis resulting from prone positioning.…”

The spectrum of COVID-19-associated chorioretinal vasculopathy

“…12/100 required ventilatory support. Not reported OCT, FA RVO or RAO (n = 5) Uveitis (n = 3) CSCR (n = 2) Larrea et al 96 15 (M = 9, F = 6) 49.7 ± 9 Mild (n = 14) Moderate (n = 1) 3.70 ± 0.82 months OCT, OCTA CRVO (n = 6) CRAO (n = 4) BRAO (n = 1) CWS (n = 7) Macular edema (n = 8) Macular atrophy (n = 4) Retinal ischemia (n = 10) Bypareddy et al 97 138 (M = 94, F = 44) 38.51 ± 14.4 Mild to moderate Median 6 days (range 1–9 days) Fundus photos Retinal streak hemorrhage (n = 1) Zapata et al 98 96 (M = 34, F = 35) 41.3 No symptoms (n = 24) Moderate (n = 24) Severe (n = 21) Within 3 months of confirmed COVID-19 infection. OCT, OCTA Retinal hemorrhages (n = 1) Sim et al 99 108 COVID-19+ patients 36 ± 5.4 Mild Fundus exams were performed between 12 and 20 days after PCR diagnosis.…”