Retinal manifestations in patients following COVID-19 infection: A consecutive case series

Abstract

Purpose: To describe retinal manifestations seen in patients associated with COVID-19 infection at a multi-specialty tertiary care hospital in Southern India. Methods: In this retrospective chart review, all consecutive cases presenting to the Retina-Uveitis service from May 2020 to January 2021 with retinal manifestations associated with COVID-19 infection or its sequelae or as a result of treatment given for COVID-19 were included. Results: Of the 7 patients, 3 were female, and 4 were male. Four patients had onset of symptoms during the active phase of COVID-19 infection. Four had bilateral and three had unilateral involvement. The manifestations ranged from mild to vision threatening. Vision threatening manifestations included infections: endogenous endophthalmitis, candida retinitis and tubercular choroidal abscess and bilateral pre-foveal hemorrhages. Milder manifestations included paracentral acute middle maculopathy, central serous chorio-retinopathy and voriconazole induced visual symptoms. Final visual acuity was 6/36 or better in the four severe cases and 6/9 or better in the mild cases. Conclusion: This study highlights the retinal manifestations associated with COVID-19 infection and its sequelae. As these patients presented with an association with COVID-19 (either during or after recovery), ophthalmologists should be vigilant and screen for such entities in case of complaints of visual symptoms or in the presence of systemic sepsis. The outcomes can be good with prompt and aggressive management.

From hazy dusk till dawn

“…A combination of oral and intravitreal antifungal agents with pars-plana vitrectomy has proven to be successful. [ 2 3 ] In our case, pars plana vitrectomy, intravitreal amphotericin B injection, and maintenance dose of oral itraconazole showed a significant clinical response. High index of suspicion, targeted investigations, and expedited intervention may help salvage the vision in patients with post-COVID-19 endogenous fungal endophthalmitis.…”

Utility of 2-Deoxy-2-[18F]fluoro-Dglucose positron emission tomography/computed tomography scan in the systemic evaluation of patients with post-COVID-19 endogenous presumed fungal endophthalmitis

“…Post-COVID-19 endogenous endophthalmitis is increasingly being recognized, and identification of the systemic focus and its treatment is an integral part of treatment. [ 1 ] Fungal endophthalmitis due to mucor species has only rarely been reported. [ 2 ] The use of a FDG PET/CT scan allowed identification of a pulmonary focus and suggested potential sites of biopsy, thus increasing the possibility of a positive diagnosis.…”

Comment on: Retinal manifestations in patients following COVID-19 infection

“…We read with interest the case series by Goyal et al . [ 1 ] titled “Retinal manifestations in patients following COVID-19 infection: A consecutive case series”. After going through the article, we think that most cases were potential retinal pathologies from the side effects of medication, particularly systemic steroids, used for the management of the coronavirus disease 2019 (COVID-19) infection or its sequelae.…”

“…Early morning sputum culture results for acid-fast bacilli were not presented by the authors despite a negative Mantoux test and Quanti-FERON-TB Gold test. [ 1 ] Also, airborne COVID-19 cases might have been hospitalized in the same isolation facilities simultaneously treating open pulmonary tuberculosis patients, where cross-infection might be another possibility. [ 4 ]…”