Fundus Lesions in Patients Hospitalized With COVID-19 Infection in Mumbai, India: A Retrospective Review

Abstract

Background and objective Coronavirus disease 2019 (COVID-19) is a viral infection that has grown to be a global pandemic, and it is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The ocular involvement in COVID-19, both in the anterior and posterior segments, is increasingly being recognized by ophthalmologists. We report the fundus photographic and systemic findings in 25 patients without recent-onset visual symptoms who were hospitalized with COVID-19. Methods Patients with COVID-19 infection who were admitted to an isolation ward/ICU in Mumbai, India during June-August 2020 underwent a comprehensive clinical and systemic evaluation. We performed a fundus evaluation using a handheld fundus camera during their admission period. We conducted a retrospective case record review and extracted demographic characteristics, laboratory findings, and fundus photographs from each case record. Results We screened 25 non-consecutive patients, and they included 20 (80%) men and five (20%) women, with ages ranging from 31 to 79 years (mean: 56.3 years). Systemically, the spectrum of severity on admission varied from mild to moderate to severely ill. The majority of the patients had no complaints of recent visual loss. An analysis of fundus photographs of 50 eyes of 25 patients revealed no evidence of fundus lesions in as many as 48 photographs. Two photographs of two eyes of patients showed incidental lesions. Conclusions We found no evidence of vascular, inflammatory, or thromboembolic disease that could be linked to COVID-19 infection in any of the images we studied; however, fundus examination may be utilized in patients with co-infection.

Ophthalmic Screening in Patients with Coronavirus Disease 2019: A Prospective Cohort Study

“…Some reports suggest high incidences of retinal lesions, while other studies did not find any signs of intraocular manifestations [ 22 , 23 ]. Various mechanisms of nervous system and ocular involvement in COVID-19 are under debate including cytokine dysregulation (referred to as “cytokine storm”), vascular endothelial injury and ischemic processes triggered by hypercoagulability, direct viral cytotoxicity as well as secondary damages mediated by aggravation of pre-existing hypoxia and HT [ 9 , 11 , 18 , 20 , 24 , 25 , 26 , 27 ].…”

“…Median best corrected visual acuity (BCVA) was 0.1 (0-1.8) Logarithm of the Minimum Angle of Resolution (LogMAR) in the right eye (oculus dexter; OD) as well as in the left eye (oculus sinister; OS) (mean BCVA 0.198 ± 0.32 (±standard deviation) LogMAR OD; mean BCVA 0.19 ± 0.34 LogMAR OS). Median intraocular pressure (IOP) was 16 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) mmHg OD and 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) mmHg OS (mean IOP 15.8 ± 3.12 mmHg OD; 16.1 ± 2.74 mmHg OS).…”

“…Such retinal findings, however, are highly unspecific and therefore prone to be confounded by prevalent cardiovascular co-morbidities. Indeed, in another retrospective review of fundus photographs of COVID-19 patients, no evidence of retinal lesions was found [ 20 ]. Thus, the nature and frequency of intraocular involvement in COVID-19 is yet to be clarified [ 15 ], calling for a “thorough ophthalmological examination in a representative cohort of patients” [ 9 ].…”

Headache and cognitive disturbance correlate with ganglion cell layer thickness in patients who recovered from COVID-19

“…In this study, we utilized thickness of the ganglion cell layer measured by OCT as an indirect measure of subtle retinal involvement in COVID-19, since the retina is generally normal on fundoscopic examination [18] . The presence of anosmia or ageusia -the signs of other cranial nerve involvements- appear to be unrelated to retinal involvement.…”