Retinal vessels modifications in acute and post-COVID-19

Abstract

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.

The impact of acute COVID-19 on the retinal microvasculature assessed with multimodal imaging

“…The more significant impact on venular diameter could reflect higher compliance or a different expression of inflammatory or ACE-2 receptors in the venular vessel wall. Similar vascular alterations were observed in the retina of patients recovered from the COVID-19 [ 13 , 26 ]; moreover, vessel dilatation was also observed in the lungs of patients with the COVID-19 pneumonia [ 24 ], which could indicate SARS-CoV-2-induced vascular remodeling and angiopathy. Even though the measured differences in our study are small, especially in the MAD, they are clearly visible in the fundus photographs.…”

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…Balance and gait may be assessed and compared with age-based norms. For patients with changes in visual acuity or eye pain, a low threshold for a post-COVID-19 retinal examination seems reasonable given that the eyes are known to have ACE 2 and such examinations can be a window into microvascular alterations affecting the whole body 76 , 77 .…”

SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death

“…By measuring sublingual microcirculation for vessels smaller than 20 μm in 12 severely ill COVID-19 patients, Damiani et al [ 188 ] found an inverse correlation between the plasma level of D-Dimer, the perfused vessel density, and the pO2/FiO2 value [ 189 ]. In that study, the D-Dimer plasma level ranged between 717 and 5536 ng/mL.…”