Myths and Truths of the Association of Retinal Vascular Occlusion With Covid-19

Sharma, Ashish; Parachuri, Nikulaa; Kumar, Nilesh; Romano, Mario R.; Parolini, Barbara; Özdek, Şengül; Tawfik, Mohamed A; Marashi, Ameen; Kuppermann, Baruch D.; Nguyen, Quan Dong

doi:10.1097/iae.0000000000003371

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…Baseline BCVA was the only significant predictor for BCVA changes among previously treated subjects in a multivariable regression analysis. Several recent studies have stated that most of the missing followup visits in the COVID19 period belonged to the elderly popula tion [28,29]; however, we showed no significant age dif ference between 2020 and 2019. Better baseline BCVA is a known predictor for final BCVA, and in a lower baseline BCVA, a bigger improvement can be achieved [11,30], and we showed among study cohorts that any previous BCVA, within the second year of treatment forward, is a significant BCVA predictor for the following year.…”

Section: Discussioncontrasting

confidence: 83%

COVID-19 Pandemic Lockdowns’ Impact on Visual Acuity of Diabetic Macular Edema: A Large Cohort

et al. 2022

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Introduction: Evaluating the impact of unplanned treatment gap, secondary to COVID-19 pandemic lockdowns, on visual acuity in previously treated diabetic macular edema (DME) patients. Methods: A multi-center, retrospective, study of DME patients, previously treated with anti-VEGF injections who were followed-up during COVID-19 pandemic (2020) comparing to pre COVID-19 period (2019) Results: A total of 634 DME patients with a mean age of 68.4 years met the inclusion criteria, 385 were assessed in 2019 (pre COVID-19) and 239 patients assessed in 2020 (COVID-19). Baseline BCVA among patients in 2019 and 2020 was 0.52±0.44, 0.45±0.43 (LogMAR, respectively). There was no significant difference between the years 2020 and 2019 in baseline BCVA (p=0.07). Mean number of anti-VEGF injections was significantly lower (5 Vs 6, p<0.01), with a major lower ratio of injections per patient in the COVID-19 first lockdown period (March-June 2020) in the COVID-19 group. Baseline BCVA (p<0.01) was the only significant predictor of final BCVA. Number of injections, age, gender and the year weren’t found as a predictor of final BCVA. Conclusions: In a large cohort of DME patients, an unplanned delay in treatment with anti- VEGF injections for 2-3 months due to COVID-19 pandemic lockdown, had no significance impact on visual acuity. For most patients, returning to routine treatment regimen was sufficient for BCVA maintaining.

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Section: Discussioncontrasting

confidence: 83%

COVID-19 Pandemic Lockdowns’ Impact on Visual Acuity of Diabetic Macular Edema: A Large Cohort

et al. 2022

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“…After ocular manifestations related to COVID-19 were reported, studies have focused on finding out whether the hypercoagulable state caused by COVID-19 can cause retinal vascular abnormality, with RVO and RAO being the most common 16 . However, although many case reports and series have reported suspected RVOs and RAOs caused by COVID-19 based on temporal relationships, the evidence for a definite correlation is yet to be found 7 – 15 , 17 . Some reports that led to the conclusion of COVID-19 as a cause or at least as a factor leading to retinal vascular complications were cases with no typical risk factors, such as old age or comorbidities, including DM or hypertension, and some bilateral cases 7 , 10 , 11 , 13 , 14 , 18 .…”

Section: Discussionmentioning

confidence: 97%

Retinal vascular occlusion risks during the COVID-19 pandemic and after SARS-CoV-2 infection

Park,

Kim,

Lee

et al. 2023

Sci Rep

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The coronavirus disease 2019 (COVID-19) has been reported to affect vascular networks including the eye. However, evidence on the causal relationship between COVID-19 infection and retinal vascular occlusions remains limited. This study aimed to determine the change in retinal vascular occlusion incidence during COVID-19 era and whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces retinal vascular occlusion. Retinal vein occlusion (RVO) and retinal artery occlusion (RAO) incidences during 2018–2019 and 2020–July 2021 were compared, those in confirmed and suspected COVID-19 patients diagnosed from 2020 to January 2021 were calculated, and those in COVID-19 patients during 180 days prior and 180 days after diagnosis were assessed. Additionally, the standardized incidence ratio of RVOs in COVID-19 patients was analyzed. Incidence rates per 100,000 people/year of RVO during 2018–2019 and 2020–2021 was 102.0 and 98.8, respectively. RAO incidence rates during 2018–2019 and 2020–2021 were 11.7 and 12.0, respectively. In both confirmed and suspected COVID-19 patients, the incidence of RVO and RAO did not change significantly from 180 days before to after diagnosis in the adjusted model. RVO incidence slightly decreased while RAO incidence increased during the COVID-19 pandemic. SARS-CoV-2 infection did not significantly increase RVO or RAO incidence.

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“…Although the fluorescein angiography revealed some area of peripheral vasculitis, the blood test was negative for any autoimmune disease markers, and no other prothrombotic conditions were found. According to Sharma et al, the reported cases related to vascular occlusion in COVID-19 infection should be associated with deranged coagulation and inflammatory parameters in the absence of confounding factors [9].…”

Section: Discussionmentioning

confidence: 98%

Central Retinal Vein Occlusion after COVID-19 Infection

Nguyen

Eandi

Guex-Crosier

2023

Klin Monbl Augenheilkd

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Introduction Central retinal vein occlusions are not well-known complications of SARS-CoV-2 infection. We describe a case of central retinal vein occlusion secondary to COVID-19, and a review of the literature was performed. History and Signs A 47-year-old woman with no underlying ocular or medical condition presented to the hospital complaining about sudden onset of multiple scotomas in her left eye. A COVID-19 infection was confirmed 2 days previously by a PCR test that was performed 2 days after the onset of symptoms. Medical history revealed no risk factors and no oral contraception. Her best-corrected visual acuity was 1.0 in the right eye and 0.04 in the left eye. Clinical exam showed a left relative afferent pupillary defect and a nasally localized papilledema on fundoscopy of the left eye. Multiple dot and blot hemorrhages were also present. Optical coherence tomography revealed cystoid macular edema and paracentral acute middle maculopathy. The results of the fluoresceine angiography were consistent with central retinal vein occlusion. Laboratory workup later revealed an elevated fibrinogen level, corresponding to the COVID-19-induced hypercoagulable state. No other prothrombotic conditions were found. The patient immediately received an intravitreal injection of Lucentis (ranibizumab) after diagnosis. Complete resolution of the retinal hemorrhages and papilledema was observed 1.5 months after treatment and the final visual acuity was 1.25 in the left eye. Conclusion Coagulation abnormalities are frequently observed in infectious diseases such as COVID-19 infection and the resulting prothrombotic state can sometimes lead to retinal vascular complications, including central retinal vein occlusion, irrespective of the presence of other classical risk factors. The consideration of this information could help clinicians establish a prompt diagnosis and therefore appropriate treatment, which could hopefully lead to complete healing of retinal lesions.

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Myths and Truths of the Association of Retinal Vascular Occlusion With Covid-19

Cited by 10 publications

References 24 publications

COVID-19 Pandemic Lockdowns’ Impact on Visual Acuity of Diabetic Macular Edema: A Large Cohort

COVID-19 Pandemic Lockdowns’ Impact on Visual Acuity of Diabetic Macular Edema: A Large Cohort

Retinal vascular occlusion risks during the COVID-19 pandemic and after SARS-CoV-2 infection

Central Retinal Vein Occlusion after COVID-19 Infection

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