Severe COVID-19 and Retina: Are There Any Retinal Manifestations?

Abstract

Purpose To investigate whether there are retinal lesions associated with severe COVID-19.

Methods We studied 232 symptomatic subjects aged 18 – 65 years who had severe COVID-19 and had received treatment. The evaluations included ophthalmological examinations, optical coherence tomography (OCT), imaging modalities with near infrared reflectance (NIR), fundus autofluorescence (FAF), and fundus photography (FP).

Results The mean age of the patients was 49 years, and 67.6% of them were men. There were no findings of microhemorrhage, cotton wool spots (CWS), vitritis, or retinitis in the examination and imaging.

Conclusions This study indicates that retinal involvement as a complication associated with COVID-19 is questionable, although some reports have demonstrated a relationship that may occur secondary to existing systemic diseases.

Zusammenfassung

Zweck Untersuchung, ob mit schwerem COVID-19 Netzhautläsionen verbunden sind.

Methoden Wir untersuchten 232 symptomatische Probanden im Alter von 18 bis 65 Jahren, die schweres COVID-19 hatten und behandelt wurden. Die Bewertungen umfassten ophthalmologische Untersuchungen, optische Kohärenztomografie (OCT), Bildgebungsmodalitäten mit Reflexionsvermögen im nahen Infrarot (NIR), Fundusautofluoreszenz (FAF) und Fundusfotografie (FP).

Ergebnisse Das Durchschnittsalter der Patienten betrug 49 Jahre und 67,6% von ihnen waren Männer. Bei der Untersuchung und Bildgebung wurden keine Mikrohämorrhagien, Watteflecken (CWS), Vitritis oder Retinitis festgestellt.

Schlussfolgerungen Diese Studie hebt hervor, dass die Beteiligung der Netzhaut als Komplikation im Zusammenhang mit COVID-19 fraglich ist, obwohl einige Berichte einen Zusammenhang gezeigt haben, der sekundär zu bestehenden systemischen Erkrankungen auftreten kann.

Key words

COVID-19 - retinal findings - optical coherence tomography - fundus autofluorescence - near-infrared reflectance

Schlüsselwörter

COVID-19 - Netzhautbefund - optische Kohärenztomografie - Fundusautofluoreszenz - Nahinfrarotreflexion

Publication History

Received: 09 March 2021

Accepted: 05 June 2021

Article published online:
15 September 2021

• References

• 1 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506
• 2 Seah I, Agrawal R. Can the coronavirus disease (COVID-19) affect the eyes? A review of coronaviruses and ocular implications in humans and animals. Ocul Immunol Inflamm 2019; 28: 391-395
• 3 Wang Y, Detrick B, Yu Z. et al. The role of apoptosis within the retina of coronavirus-infected mice. Invest Ophthalmol Vis Sci 2000; 41: 3011-3018
• 4 Casagrande M, Fitzek A, Püschel K. et al. Detection of SARS-CoV-2 in human retinal biopsies of deceased COVID-19 patients. Ocul Immunol Inflamm 2020; 28: 721-725
• 5 Senanayake P, Drazba J, Shadrach K. et al. Angiotensin II and its receptor subtypes in the human retina. Invest Ophthalmol Vis Sci 2007; 48: 3301-3311
• 6 Tang YW, Schmitz JE, Persing DH. et al. The laboratory diagnosis of COVID-19 infection: current issues and challenges. J Clin Microbiol 2020; 58: e00512-e00520
• 7 Varga Z, Flammer AJ, Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395: 1417-1418
• 8 Invernizzi A, Torre A, Parrulli S. et al. Retinal findings in patients with COVID-19: Results from the SERPICO-19 study. EClinicalMedicine 2020; 27: 100550
• 9 Landecho MF, Yuste JR, Gándara E. et al. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease?. J Intern Med 2021; 289: 116-120
• 10 Marinho PM, Marcos AAA, Romano AC. et al. Retinal findings in patients with COVID-19. Lancet 2020; 395: 1610
• 11 Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost 2020; 26: 1076029620938149
• 12 Vavvas DG, Sarraf D, Sadda SR. et al. Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent Lancet publication. Eye (Lond) 2020; 34: 2153-2154
• 13 Tsang SH, Sharma T. Fundus Autofluorescence. Adv Exp Med Biol 2018; 1085: 15-16
• 14 Tsang SH, Sharma T. Optical Coherence Tomography. Adv Exp Med Biol 2018; 1085: 11-13
• 15 Elsner AE, Burns SA, Weiter JJ. et al. Infrared imaging of sub-retinal structures in the human ocular fundus. Vision Res 1996; 36: 191-205
• 16 Hazirolan D, Sungur G, Demir N. et al. Focal posterior pole viral retinitis. Eur J Ophthalmol 2010; 20: 925-930
• 17 La AM, Kurt RA, Mejor S. et al. Comparing fundus fluorescein angiography and swept-source optical coherence tomography angiography in the evaluation of diabetic macular perfusion. Retina 2018; 39: 926-937
• 18 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-513
• 19 Insausti-García A, Reche-Sainz JA, Ruiz-Arranz C. et al. Papillophlebitis in a COVID-19 patient: inflammation and hypercoagulable state. Eur J Ophthalmol 2020; DOI: 10.1177/1120672120947591.
• 20 Pereira LA, Soares LCM, Nascimento PA. et al. Retinal findings in hospitalised patients with severe COVID-19. Br J Ophthalmol 2020; DOI: 10.1136/bjophthalmol-2020-317576.