Late retinal and optic nerve vascular complications due to COVID-19 in young individuals

Abstract

Purpose This study aims to describe the late retinal and optic nerve vascular complications due Coronavirus disease 2019 (COVID-19) in a Spanish young population. Methods We describe 15 eyes of 15 young patients without any other systemic risk factors, except controlled arterial hypertension in 5 of them, with the diagnosis of Central retinal vein occlusion (CRVO), Branch retinal vein occlusion (BRVO), Central retinal artery occlusion (CRAO), Branch retinal artery occlusion (BRAO), Mixed occlusions (Artery and Vein) and Non-arteritic ischemic optic neuropathy (NAION) with a previous COVID-19 infection demonstrated with a positive COVID-19 IgG Test (COVID-19 IgG/IgM Rapid Test Cassette, Lambra Laboratories, Madrid, Spain. Results 9 males and 6 females, with a mean age of presentation of 49.7 ± 9 years old were included. The mean time between infection and diagnosis of the disease was 3.5 ± 1.2 months. The most common retinal or optic nerve vascular complication was CRVO (6 cases), following by CRAO (4 cases), Mixed arterial and venous occlusions (2 cases), NAION (2 cases) and BRAO (1 case). Conclusions The presence of a retinal or optic nerve vascular event in a young patient without any other hypercoagulable or genetic thrombophilic disorder, should make us rule out a previous COVID-19 infection. Ophthalmologists must be awared that retinal circulation could be another potential site for thromboembolic and optic nerve circulatory insufficiency complications of COVID-19. To our knowledge, this is the longest case series of retinal or optic nerve vascular events described after COVID-19 infection.

Central retinal artery occlusion with cilioretinal artery sparing secondary to COVID-19: Additional ocular complication

“…One of them spared the cilioretinal artery,[ 7 ] but this patient had a CRAO 4 months after COVID infection and had gone through minor symptoms, no hospitalization, and with previous COVID-19 infection confirmed by COVID-19 IgG test. [ 7 ] Our case developed CRAO with spared cilioretinal artery 11 days after discharge from hospitalization that required oxygen supplementation for severe COVID-19, had a positive RT-PCR for SARS-CoV-2 and several proinflammatory and procoagulant factors in her laboratory tests.…”

Non-Arteritic Anterior Ischemic Optic Neuropathy Following COVID-19 Vaccination

“…Rho et al reported a 43-year-old male with underlying systemic diseases of diabetes mellitus and borderline hyperlipidemia presenting NAION two weeks after testing positive for SARS-CoV-2 by nasal swabbing [12]. Additionally, Larrea et al presented two cases of NAION after COVID-19 disease diagnosis, even though the 39-year-old female and 58-year-old male had no systemic risk factors for NAION [13]. These three patients all met the characteristics of minimal or no cardiovascular risk factors and experienced an early onset of NAION described by Kuhli-Hattenbach et al, and the authors argued that the hypoxemia and hypercoagulability caused by COVID-19 might contribute to the development of NAION [12,13].…”

“…Additionally, Larrea et al presented two cases of NAION after COVID-19 disease diagnosis, even though the 39-year-old female and 58-year-old male had no systemic risk factors for NAION [13]. These three patients all met the characteristics of minimal or no cardiovascular risk factors and experienced an early onset of NAION described by Kuhli-Hattenbach et al, and the authors argued that the hypoxemia and hypercoagulability caused by COVID-19 might contribute to the development of NAION [12,13]. As compared with the above three cases, our patient also had minimal cardiovascular risk factors (controlled hypertension and borderline hyperlipidemia) despite developing NAION at an older age of 61 years, and the previous two reported cases of patients who experienced early-onset NAION (aged 46 and 55 years) also met the characteristics of no systemic risk factors described by Kuhli-Hattenbach et al [3,8].…”

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.…”