Optical coherence tomography angiography findings in patients with COVID-19

Türker, İbrahim Çağrı; Doğan, Ceylan Uslu; Güven, Dilek; Kutucu, Oğuz Kaan; Gul, Cengiz

doi:10.1016/j.jcjo.2020.12.021

Cited by 67 publications

(85 citation statements)

References 20 publications

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“…Either way, regarding the novelty of COVID-19 and its many unknown faces, every practitioner managing these patients should anticipate various clinical pictures and organ system involvement and treat the variable clinical presentations of COVID-19 as a rule and not an exception. Regarding to accumulative evidences on retinal and choroidal changes due to COVID-19 infection in this report and previous reports [24][25][26][27][28], we could propose the COVID-19 infection as a new etiology for pachychoroid spectrum disorder.…”

Section: Discussionsupporting

confidence: 51%

“…COVID-19 is associated with widespread microangiopathy; thus, changes of blood flow in the retina and choroid are potential. In recent case-control studies, alterations of retinal microvasculature are found subsequent to COVID-19 infections compared to healthy control groups [ 24 , 25 ]. Moreover, in a case-control study in patients stratified to mild, moderate, and severe COVID-19 disease activity and normal controls, patients with moderate and severe disease had decreased macular vascular density (VD) on OCT-angiography (OCT-A) as compared with control subjects or even those who were asymptomatic or paucisymptomatic [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Pachychoroid Spectrum Disorder Findings in Patients with Coronavirus Disease 2019

Abrishami

Daneshvar

Shoeibi

et al. 2021

Case Reports in Ophthalmological Medicine

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Purpose. To report the occurrence of acute, bilateral, central serous chorioretinopathy (CSC), and pachychoroid spectrum disorder findings in patients with coronavirus disease 2019 (COVID-19). Methods. In recovered cases of COVID-19 with visual disturbances, complete ocular examinations with multimodal retinal and choroidal evaluation, including enhanced depth imaging optical coherence tomography, fluorescein or indocyanine green angiography, and blue autofluorescence, were obtained. Results. Four COVID-19 recovered patients presented with bilateral blurred vision. Ocular examination and imaging revealed pachychoroid and pachyvessels associated with choroidal hyperpermeability without any obvious intraocular inflammation. Bilateral localized serous retinal detachment was obvious in three cases compatible with pachychoroid associated with CSC manifestation and pachychoroid pigment epitheliopathy in one patient. CSC was resolved with treatment by steroidal antimineralocorticoid (Eplerenone) in two patients and by photodynamic therapy in one patient. None of the patients reported emotional stress and history of corticosteroid consumption. Conclusion. Hyperpermeability of the choroid, pachychoroidopathy, or choroidal vessel congestion can be observed or exacerbated in association with COVID-19.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Pachychoroid Spectrum Disorder Findings in Patients with Coronavirus Disease 2019

Abrishami

Daneshvar

Shoeibi

et al. 2021

Case Reports in Ophthalmological Medicine

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“…This suggests that haemorrhages and cotton wools, which have commonly been reported in COVID-19 6 , 28 , along with other thrombotic events to the retinal vasculature 7 , 8 , are likely related to an impairment to the retinal microcirculation 28 induced by the transient hypercoagulability 20 and the endothelial disfunction 29 typical of the acute phase of the disease. Such damage to the microcirculation may persist at a subclinical level according to optical coherence tomography studies which demonstrated a decreased vascular density in the macular 10 and peripapillary area 12 of post-COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Retinal vessels modifications in acute and post-COVID-19

Invernizzi

Schiuma

Parrulli

et al. 2021

Sci Rep

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Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 primarily affecting the respiratory system which can damage vessels walls virtually in any body district. Changes affecting retinal vessels are a good marker for systemic vascular alterations. This study investigated retinal vessels during the acute phase of COVID-19 and after patients recovery. Fifty-nine eyes from 32 COVID-19 patients and 80 eyes from 53 unexposed subjects were included. Mean arteries diameter (MAD) and mean veins diameter (MVD) were assessed through semi-automatic analysis on fundus color photos at baseline and 6 months later in patients and subjects unexposed to the virus. At baseline MAD and MVD were significantly higher in COVID-19 patients compared to unexposed subjects (p < 0.0001). Both MAD and MVD significantly decreased in COVID-19 patients at follow-up (from 97.5 ± 10.9 to 92.2 ± 11.4 µm, p < 0.0001 and from 133.1 ± 19.3 to 124.6 ± 16.1 µm, p < 0.0001, respectively). Despite this reduction vessels diameter remained significantly higher in severe COVID-19 patients compared to unexposed subjects. Transient retinal vessels dilation could serve a biomarker for systemic inflammation while long-lasting alterations seen in severe COVID-19 likely reflect irreversible structural damage to the vessels walls and should be further investigated for their possible effects on tissues perfusion and function.

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“…[16][17][18][19] Several investigators have reported alterations in the retinal microvasculature in COVID-19 patients as assessed by OCT angiography, including reduced retinal and foveal-centered vessel density. [20][21][22] Postmortem ocular tissue studies have demonstrated evidence of intraocular SARS-CoV-2 in some cases of COVID-19. 23,24 Documented severe visual loss related to COVID-19 has been reported, including acute retinal necrosis 25 and acute viral retinitis, 26 with confirmed SARS-CoV-2 positivity on vitreous testing.…”

mentioning

confidence: 99%

Expression of the SARS-CoV-2 Receptor ACE2 in Human Retina and Diabetes—Implications for Retinopathy

Zhou

Guerra

et al. 2021

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To investigate the expression of angiotensin-converting enzyme 2 (ACE2), the receptor for SARS-CoV-2 in human retina. METHODS.Human post-mortem eyes from 13 non-diabetic control cases and 11 diabetic retinopathy cases were analyzed for the expression of ACE2. To compare the vascular ACE2 expression between different organs that involve in diabetes, the expression of ACE2 was investigated in renal specimens from nondiabetic and diabetic nephropathy patients. Expression of TMPRSS2, a cell-surface protease that facilitates SARS-CoV-2 entry, was also investigated in human nondiabetic retinas. Primary human retinal endothelial cells (HRECs) and primary human retinal pericytes (HRPCs) were further used to confirm the vascular ACE2 expression in human retina. RESULTS.We found that ACE2 was expressed in multiple nonvascular neuroretinal cells, including the retinal ganglion cell layer, inner plexiform layer, inner nuclear layer, and photoreceptor outer segments in both nondiabetic and diabetic retinopathy specimens. Strikingly, we observed significantly more ACE2 positive vessels in the diabetic retinopathy specimens. By contrast, in another end-stage organ affected by diabetes, the kidney, ACE2 in nondiabetic and diabetic nephropathy showed apical expression of ACE2 tubular epithelial cells, but no endothelial expression in glomerular or peritubular capillaries. Western blot analysis of protein lysates from HRECs and HRPCs confirmed expression of ACE2. TMPRSS2 expression was present in multiple retinal neuronal cells, vascular and perivascular cells, and Müller glia. CONCLUSIONS.Together, these results indicate that retina expresses ACE2 and TMPRSS2. Moreover, there are increased vascular ACE2 expression in diabetic retinopathy retinas.

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Optical coherence tomography angiography findings in patients with COVID-19

Cited by 67 publications

References 20 publications

Pachychoroid Spectrum Disorder Findings in Patients with Coronavirus Disease 2019

Pachychoroid Spectrum Disorder Findings in Patients with Coronavirus Disease 2019

Retinal vessels modifications in acute and post-COVID-19

Expression of the SARS-CoV-2 Receptor ACE2 in Human Retina and Diabetes—Implications for Retinopathy

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