Peripapillary Retinal Vascular Involvement in Early Post-COVID-19 Patients

Abstract

The ability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2′s) to cause multi-organ ischemia and coronavirus-induced posterior segment eye diseases in mammals gave concern about potential sight-threatening ischemia in post coronavirus disease 2019 patients. The radial peripapillary capillary plexus (RPCP) is a sensitive target due to the important role in the vascular supply of the peripapillary retinal nerve fiber layer (RNFL). Eighty patients one month after SARS-CoV-2 infection and 30 healthy patients were selected to undergo structural OCT (optical coherence tomography) and OCTA (optical coherence tomography angiography) exams. Primary outcome was a difference in RPCP perfusion density (RPCP-PD) and RPCP flow index (RPCP-FI). No significant difference was observed in age, sex, intraocular pressure (IOP) and prevalence of myopia. RPCP-PD was lower in post SARS-CoV-2 patients compared to controls. Within the post-COVID-19 group, patients with systemic arterial hypertension had lower RPCP-FI and age was inversely correlated to both RPCP-FI and RPCP-PD. Patients treated with lopinavir + ritonavir or antiplatelet therapy during admission had lower RPCP-FI and RPCP-PD. RNFL average thickness was linearly correlated to RPCP-FI and RPCP-PD within post-COVID-19 group. Future studies will be needed to address the hypothesis of a microvascular retinal impairment in individuals who recovered from SARS-CoV-2 infection.

Choroidal Thickening in Patients with Coronavirus Disease – 2019

“…In a recent article by Savastano and colleagues, the authors reported a higher choroidal thickness in patients recovered from COVID-19; however, the difference was not statistically signi cant. [14] The average SFCT in our patients was almost 70 µm higher than the previously reported thickness in normal subjects with the same ethnic background. Rahman and coworkers reported that a change in SFCT more than 32 µm is more than interobserver variability and could be a true change; [48] however, they used the enhanced depth imaging (EDI) protocol on a different machine (Spectralis; Heidelberg Engineering, Heidelberg, Germany) to measure SFCT.…”

“…In a recent report, Savastano and associates highlighted peripapillary vascular changes in patients recovered from COVID-19, which indicate the involvement of ocular vasculature in this disease. [14] SARS-CoV-2 uses the angiotensin-converting enzyme (ACE) 2 receptor to enter the host cells and downregulates the ACE2. [20,21] The ACE2 is a major role player in the renin-angiotensin-aldosterone system (RAAS).…”

“…[13] As vascular involvement is a well-identi ed aspect of COVID-19 and peripapillary vascular changes have been reported recently, it is not surprising to expect chorioretinal involvement in these patients. [14] Hereby, we presented detailed SD-OCT ndings of the macular region in a prospective cohort of 67 eyes of 34 patients recovered from COVID-19. We aimed to investigate the choroidal changes and the chronological relationship between SD-OCT ndings and the disease course.…”

Optical coherence tomography angiography analysis of the retina in patients recovered from COVID-19: a case-control study

“…In an autopsy study, Casagrande and associates detected SARS-CoV-2 viral ribonucleic acid in the retina of patients that had passed away due to COVID-19. 15 Given the presence of ACE2 receptors in various layers of the retina and choroid, pathoanatomical abnormalities in these ocular tissues may be expected. Reports of microvascular injury and thrombosis in patients with severe COVID-19 infection would appear to highlight the importance of evaluating retinal vascular involvement with this disease.…”

Resident Perspectives 56–1

“… 1 Similarly, findings from another study suggested an impairment in the blood supply to the peripapillary retinal nerve fiber layer in patients who recovered from SARS-CoV-2, but microvascular impairment was more evident in older patients and in patients with systemic hypertension. 2 However, the study by Abrishami and colleagues included patients who were young and otherwise healthy. Only one of their patients was medically managed for hypertension.…”