Retinal findings in hospitalised patients with severe COVID-19

Pereira, Leonardo Amarante; Soares, Larissa Caroline Mansano; Nascimento, Priscila Alves; Cirillo, Luciano Rabello Netto; Sakuma, Hebert Toshiaki; Veiga, Gláucia Luciano da; Fonseca, Fernando L. A.; Lima, Vagner Loduca; Abucham-Neto, Júlio Zaki

doi:10.1136/bjophthalmol-2020-317576

Cited by 135 publications

(147 citation statements)

References 14 publications

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“…All these could be considered signs of retinal vascular impairment following thrombotic complications. 7 , 8 , 9 , 30 , 31 Hitherto, only one report conducted by Savastano et al used OCTA imaging in Covid-19 patients. 32 The authors demonstrated a reduction of perfusion density of the radial peripapillary capillary plexus in Covid-19 patients compared to healthy controls after one month from infection.…”

Section: Discussionmentioning

confidence: 99%

“…However, it was not possible to clearly establish whether these signs were secondary to COVID-19 or just incidental findings, given the high presence of comorbidities in the general population. 7 , 8 , 9 Optical coherence tomography angiography (OCTA), a new non-invasive imaging technique, may provide qualitative and quantitative features of retinal and choroidal vascularization and could monitor the changes of vascular perfusion in patients with Covid-19. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

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Optical Coherence Tomography Angiography Features in Post-COVID-19 Pneumonia Patients: A Pilot Study

Cennamo

Reibaldi

Montorio

et al. 2021

American Journal of Ophthalmology

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Purpose : To investigate retinal vessel density changes in macular and papillary regions in post SARS-CoV-2 pneumonia patients by means of optical coherence tomography angiography (OCTA). Design : Prospective, observational, cohort study. Methods : Forty eyes of 40 patients (mean age 49.7 ± 12.6) post SARS-CoV-2 infection and 40 healthy subjects were enrolled in this study. Covid-19 patients had to be fully recovered from Covid-19 pneumonia and were evaluated 6 months after Covid-19 infection. The primary outcome was the results of the OCTA study of the following vascular structures: vessel density (VD) in the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillaries (RPC), compared to those of controls. We also evaluated the structural spectral domain (SD)-OCT parameters: ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL). Results : The patients showed a significant reduction in VD of the SCP in whole image and in the DCP in all sectors compared to healthy subjects (p<0.05). Covid-19 patients featured a reduced VD of the RPC compared to controls (p<0.001). No difference was found in the GCC, while the RNFL was reduced in the COVID-19 group compared to controls (p=0.012). Significant correlations were found between the RNFL and VD of the SCP, DCP, RPC and FAZ area in the Covid-19 group (p<0.05). Conclusion : OCTA showed retinal vascular changes in subjects fully recovered from Covid-19 pneumonia. These findings could be a consequence of a thrombotic microangiopathy that affected retinal structures as well as other systemic organs. OCTA could represent a valid, non-invasive biomarker of early vascular dysfunction after SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optical Coherence Tomography Angiography Features in Post-COVID-19 Pneumonia Patients: A Pilot Study

Cennamo

Reibaldi

Montorio

et al. 2021

American Journal of Ophthalmology

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“… 19 Further, in a case series of patients with severe COVID-19, 10 out of 18 patients had retinal abnormalities such as flame-shaped haemorrhages or cotton-wool spots, suggesting involvement of retinal vasculature. 20 Although our patient was not critically ill, it cannot be ruled out that the haemorrhage was related to the SARS-CoV-2 infection. Contact tracing after the positive PCR-test was obtained did not reveal any transmission to hospital staff.…”

Section: Discussionmentioning

confidence: 77%

No findings of SARS-CoV-2 in conjunctival swabs from patients at an emergency outpatient ophthalmological healthcare facility in a Swedish county hospital: a cross-sectional study

Krifors

Freyhult

Åkerblom³

2021

BMJ Open Ophth

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BackgroundCOVID-19 is caused by SARS-CoV-2. Virus has been found in conjunctiva of hospitalised patients with COVID-19. Conjunctivitis has also been reported as a presenting symptom of disease.ObjectiveThe aims of the study were to investigate the prevalence of SARS-CoV-2 in the conjunctiva and throat among patients presenting at the emergency outpatient ophthalmological healthcare facility at a county hospital along with investigating the seroprevalence of SARS-CoV-2 among staff at the department.Methods and AnalysisSwabs from conjunctiva and throat of patients were analysed with real-time reverse transcriptase PCR (RT-PCR) for SARS-CoV-2. Blood samples for serological analysis were obtained from staff. A questionnaire was used to investigate symptoms associated with COVID-19 during the last 3 months as well as symptoms for which the patients were seeking ophthalmological healthcare.ResultsIn total, 68 patients and 70 individuals from the staff were included in the study. Conjunctivitis was observed in 7% of patients. One patient, presenting with reduced visual acuity due to preretinal haemorrhage in the macula, was positive for SARS-CoV-2 in throat swab. Contact tracing was negative. All other RT-PCR tests were negative. Seropositivity for SARS-CoV-2 was found in 4% of staff.ConclusionsOur study demonstrated low prevalence of SARS-CoV-2 among patients as well as low seroprevalence of SARS-CoV-2 IgG-antibodies among staff at the ophthalmological ward. The risk for contracting COVID-19 at the department was small. Follow-up investigation is planned.

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“…They suggested a potential role of fundus examination in patients with co-infection. In contrast, Pereira et al have reported the findings of a cohort of 18 hospitalized patients from Brazil, of whom 10 (55.5%) had detectable retinal lesions (hemorrhages, cotton wool spots) on dilated fundus examination via photography [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Fundus Lesions in Patients Hospitalized With COVID-19 Infection in Mumbai, India: A Retrospective Review

Mehta¹,

Prabhudesai²

2020

Cureus

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Background and objective Coronavirus disease 2019 (COVID-19) is a viral infection that has grown to be a global pandemic, and it is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The ocular involvement in COVID-19, both in the anterior and posterior segments, is increasingly being recognized by ophthalmologists. We report the fundus photographic and systemic findings in 25 patients without recent-onset visual symptoms who were hospitalized with COVID-19. Methods Patients with COVID-19 infection who were admitted to an isolation ward/ICU in Mumbai, India during June-August 2020 underwent a comprehensive clinical and systemic evaluation. We performed a fundus evaluation using a handheld fundus camera during their admission period. We conducted a retrospective case record review and extracted demographic characteristics, laboratory findings, and fundus photographs from each case record. Results We screened 25 non-consecutive patients, and they included 20 (80%) men and five (20%) women, with ages ranging from 31 to 79 years (mean: 56.3 years). Systemically, the spectrum of severity on admission varied from mild to moderate to severely ill. The majority of the patients had no complaints of recent visual loss. An analysis of fundus photographs of 50 eyes of 25 patients revealed no evidence of fundus lesions in as many as 48 photographs. Two photographs of two eyes of patients showed incidental lesions. Conclusions We found no evidence of vascular, inflammatory, or thromboembolic disease that could be linked to COVID-19 infection in any of the images we studied; however, fundus examination may be utilized in patients with co-infection.

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Retinal findings in hospitalised patients with severe COVID-19

Cited by 135 publications

References 14 publications

Optical Coherence Tomography Angiography Features in Post-COVID-19 Pneumonia Patients: A Pilot Study

Optical Coherence Tomography Angiography Features in Post-COVID-19 Pneumonia Patients: A Pilot Study

No findings of SARS-CoV-2 in conjunctival swabs from patients at an emergency outpatient ophthalmological healthcare facility in a Swedish county hospital: a cross-sectional study

Fundus Lesions in Patients Hospitalized With COVID-19 Infection in Mumbai, India: A Retrospective Review

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