Retinal microvascular signs in COVID-19

Abstract

Background/aimsTo explore if retinal findings are associated with COVID-19 infection.MethodsIn this prospective cross-sectional study, we recruited participants positive for COVID-19 by nasopharyngeal swab, with no medical history. Subjects underwent retinal imaging with an automated imaging device (3D OCT-1 Maestro, Topcon, Tokyo, Japan) to obtain colour fundus photographs (CFP) and optical coherence tomographic (OCT) scans of the macula. Data on personal biodata, medical history and vital signs were collected from electronic medical records.Results108 patients were recruited. Mean age was 36.0±5.4 years. 41 (38.0%) had symptoms of acute respiratory infection (ARI) at presentation. Of 216 eyes, 25 (11.6%) had retinal signs—eight (3.7%) with microhaemorrhages, six (2.8%) with retinal vascular tortuosity and two (0.93%) with cotton wool spots (CWS). 11 eyes (5.1%) had hyper-reflective plaques in the ganglion cell-inner plexiform layer layer on OCT, of which two also had retinal signs visible on CFP (CWS and microhaemorrhage, respectively). There was no significant difference in the prevalence of retinal signs in symptomatic versus asymptomatic patients (12 (15.0%) vs 13 (9.6%), p=0.227). Patients with retinal signs were significantly more likely to have transiently elevated blood pressure than those without (p=0.03).ConclusionOne in nine had retinal microvascular signs on ocular imaging. These signs were observed even in asymptomatic patients with normal vital signs. These retinal microvascular signs may be related to underlying cardiovascular and thrombotic alternations associated with COVID-19 infection.

COVID-19-Related Retinal Micro-vasculopathy – A Review of Current Evidence

“…The examination was performed about 16 days after diagnosis of COVID-19 with PCV. 35 The highest prevalence of retinal microvascular abnormalities was reported by Pereira et al in a series comprising 18 COVID-19 patients with severe infection. Seventeen patients (94.4%) require ICU stay and 77.8% received invasive mechanical ventilation.…”

“…Among cases-control studies and case series, 18 publications (10 case-control studies [17][18][19][20][21][22][23][24][25]30 and 9 case series 13,28,29,[31][32][33][34][35][36] ) reported on the presence or absence of retinal signs related to micro-vasculopathy. Among the 10 case-control studies, retinal signs were reported in 6, with frequency ranging from 0.01% to 20%.…”

“…Nine case series reported retinal features in COVID-19 patients. Among these, the two largest series comprised 138 cases (mean age 38.5 years) 31 and 108 cases (36.4 years) 35 with mild to moderate infection. Examination in the largest series revealed only 1 patient with a flame hemorrhage (0.72%).…”

Ocular Manifestations In COVID-19: Clinical Case Reports And A Literature (Review)

“…Карбоксипептидазният рецептор, свързан с ангиотензин-конвертиращия ензим (АСЕ2), като таргет за SARS-CoV-2 е обилно експресиран в ретината и хориоидеята. Регулираното понижаване на този ензим по време на вирусна инфекция може да обясни развитието на ретинална исхемия [5].…”

“…Проучване на Сим и сътр. върху 108 пациенти с положителни назофарингеални проби за SARS-CoV-2 открива, че 11.6% демонстрират ретинални изменения, включително микрохеморагии, тортуозитет на съдовете и влажни ексудати с хиперрефлективни плаки на границата между ганглийно-клетъчния и вътрешния плексиформeн слой, без връзка със симптоматичния или асимптоматичния клиничен ход на респираторното заболяване [5].…”