Longitudinal analysis of cotton wool spots in <scp>COVID</scp>‐19 with high‐resolution spectral domain optical coherence tomography and optical coherence tomography angiography

Markan, Ashish; Bansal, Reema; Gautam, Neha; Ahuja, Chirag; Agarwal, Aniruddha; Katoch, Deeksha; Gupta, Vishali

doi:10.1111/ceo.13919

Cited by 10 publications

(15 citation statements)

References 6 publications

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“…No other possible explanation for these CWSs, other than that persistent changes related to COVID-19 infection were found in this patient, and at 12 months evaluation, they had disappeared. In a recent 3 months follow-up study [11], from five patients that presented CWSs in the convalescent phase of the disease, occasionally accompanied by an intraretinal hemorrhage, one patient developed recurring CWSs, as in our case. The mechanism by which CWSs could develop during COVID-19 recovery remains unclear; however, several hypotheses have been postulated to explain their development during the acute infection, including occlusive vasculopathy, angiotensin-converting enzyme 2 (ACE2) downregulation by SARS-COV-2, hypercoagulopathy, or an immune complex deposition in the vessel walls [11].…”

Section: Discussionsupporting

confidence: 70%

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Persistent Retinal Microvascular Impairment in COVID-19 Bilateral Pneumonia at 6-Months Follow-Up Assessed by Optical Coherence Tomography Angiography

et al. 2021

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The purpose of this study was to evaluate the long-term evolution of retinal changes in COVID-19 patients with bilateral pneumonia. A total of 17 COVID-19 patients underwent retinal imaging 6 months after hospital discharge with structural optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). The parafoveal retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) were significantly thinner in COVID-19 patients at 6 months compared to 0 months (p = <0.001 in both cases). In the optic nerve analysis, a significantly thinner RNFL was observed (p = 0.006) but persisted significantly thickened, compared to controls (p = 0.02). The vascular density (VD) at 6 months persisted significantly decreased when compared to the control group, and no significant differences were found with the 0 months evaluation; in addition, when analyzed separately, women showed a worsening in the VD. Moreover, a significantly greater foveal area zone (FAZ) (p = 0.003) was observed in COVID-19 patients at 6 months, compared to 0 months. The cotton wool spots (CWSs) observed at baseline were no longer present at 6 months, except for one patient that developed new ones. This study demonstrates that some of the previously known microvascular alterations resulting from COVID-19, persist over time and are still evident 6 months after hospital discharge in patients who have suffered from bilateral pneumonia.

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Section: Discussionsupporting

confidence: 70%

“…From the ocular perspective, different signs and symptoms have been described in patients with COVID 19, more commonly in those suffering from severe pneumonia [3]. Retinal involvement has been reported, including retinal hemorrhages, cotton wool spots (CWSs), dilated veins, and increased vascular tortuosity [4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Persistent Retinal Microvascular Impairment in COVID-19 Bilateral Pneumonia at 6-Months Follow-Up Assessed by Optical Coherence Tomography Angiography

et al. 2021

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“…The direct effect of viral infection, hypercoagulation and vasculopathy are proposed to be the factors leading to various retinal changes 11. The reason for the development of cotton wool spots in COVID-19 cases, as also seen in the left eye of our case, has been unclear with a unique pattern of self-resolution, localised lesions and occult nature 12. We hypothesise that COVID-19 systemic microangiopathy manifesting as transiently deranged coagulation profile could be the cause of transient vision loss with sub-ILM haemorrhage in our case.…”

Section: Descriptionmentioning

confidence: 65%

“… 11 The reason for the development of cotton wool spots in COVID-19 cases, as also seen in the left eye of our case, has been unclear with a unique pattern of self-resolution, localised lesions and occult nature. 12 We hypothesise that COVID-19 systemic microangiopathy manifesting as transiently deranged coagulation profile could be the cause of transient vision loss with sub-ILM haemorrhage in our case. Further studies to implicate the role of deranged coagulation profile in COVID-19 cases are needed before meaningful conclusions are made.…”

Section: Descriptionmentioning

confidence: 72%

Sub-internal limiting membrane haemorrhage as a manifestation of transiently deranged coagulation profile following SARS-CoV-2 infection

et al. 2022

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“…[ 3 ] Markan et al . [ 10 ] reported longitudinal analysis of cotton wool spots in COVID-19 with high-resolution spectral-domain optical coherence tomography and optical coherence tomography angiography. The primary cellular receptor for the entry of SARS-CoV-2 is the angiotensin-converting enzyme 2 (ACE2), which has been detected in the aqueous humor and the retina in humans.…”

Section: Discussionmentioning

confidence: 99%

Serial swept source optical coherence tomography of a cotton wool spot following SARS CoV2 infection

Shah

Biswas

2021

Indian Journal of Ophthalmology

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A 33-year-old male presented with history of blurring of vision in the left eye for two months. He was seen by the local ophthalmologist and diagnosed as nongranulomatous anterior uveitis in the left eye with normal fundus. He had history of fever 20 days back and was diagnosed positive for COVID-19 by RT-PCR. He presented with acute anterior uveitis in the left eye. Fundus examination revealed a cotton wool spot close to the fovea, which was confirmed by swept-source optical coherence tomography (SS-OCT) of the macula. The patient after two months’ follow-up showed resolution of the cotton wool spot, which was confirmed by SS-OCT. Our case indicates that cotton wool spot can be an ocular manifestation of COVID-19 infection, and swept-source optical coherence tomography can precisely document the resolution of the lesion.

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Longitudinal analysis of cotton wool spots in COVID‐19 with high‐resolution spectral domain optical coherence tomography and optical coherence tomography angiography

Cited by 10 publications

References 6 publications

Persistent Retinal Microvascular Impairment in COVID-19 Bilateral Pneumonia at 6-Months Follow-Up Assessed by Optical Coherence Tomography Angiography

Persistent Retinal Microvascular Impairment in COVID-19 Bilateral Pneumonia at 6-Months Follow-Up Assessed by Optical Coherence Tomography Angiography

Sub-internal limiting membrane haemorrhage as a manifestation of transiently deranged coagulation profile following SARS-CoV-2 infection

Serial swept source optical coherence tomography of a cotton wool spot following SARS CoV2 infection

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