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1.
Indian J Ophthalmol ; 70(4): 1418-1420, 2022 04.
Article in English | MEDLINE | ID: covidwho-1939183

ABSTRACT

To report a case of MEWDS post-COVID-19 infection with multimodal imaging. A 17-year-old boy reported blurring of vision in both eyes 2 months and 10 days following the SARS-CoV-2 infection. Fundus examination revealed hypopigmented lesions nasal to the optic disc, inferior periphery, and near macula in both eyes. Multimodal imaging was consistent with MEWDS. A complete systemic workup was performed to exclude infectious etiology. Fundus lesions resolved with a course of oral corticosteroids and was confirmed on multimodal imaging.


Subject(s)
COVID-19 , Retinal Diseases , White Dot Syndromes , Adolescent , Fluorescein Angiography/methods , Humans , Male , Retinal Diseases/diagnosis , SARS-CoV-2
2.
BMC Ophthalmol ; 22(1): 297, 2022 Jul 07.
Article in English | MEDLINE | ID: covidwho-1923532

ABSTRACT

BACKGROUND: Punctate inner choroidopathy (PIC) is a rare idiopathic inflammatory multifocal chorioretinopathy. Although the etiology of PIC is unknown, it is proposed to be an autoimmune disease that arises in the context of polygenic susceptibility triggered by an environmental stimulus, such as infection. We reported a case of PIC immediately after COVID-19 infection. CASE PRESENTATION: A 25-year-old woman complained of blurred vision in the right eye six days after the symptoms of COVID-19 infection first appeared. The patient visited our hospital and underwent comprehensive ophthalmological examination 18 days after the initial COVID-19 symptoms. Based on the characteristic fundus features observed with multimodal imaging, retinal specialists made a diagnosis of PIC. The patient was affected with high myopia. As her general COVID-19 symptoms disappeared, the patient was prescribed oral prednisolone 30 mg/day for 14 days to treat PIC. Fundus abnormality decreased and her ocular symptoms improved. No side effects were observed, including the recurrence of general COVID-19 symptoms. CONCLUSION: We experienced an extremely rare case of PIC immediately after COVID-19 infection and showed the potential safety and effectiveness of oral prednisolone in treating PIC in the active phase after the disappearance of the general COVID-19 infection symptoms.


Subject(s)
COVID-19 , Choroid Diseases , White Dot Syndromes , Adult , COVID-19/complications , Choroid Diseases/diagnosis , Choroid Diseases/etiology , Female , Fluorescein Angiography/methods , Humans , Prednisolone/therapeutic use , Tomography, Optical Coherence/methods
3.
Immun Inflamm Dis ; 10(6): e619, 2022 06.
Article in English | MEDLINE | ID: covidwho-1850061

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic in an unprecedented time frame. Systemic vascular involvement in COVID-19 has been identified, and SARS-CoV-2 has also been found to cause multiple organ ischemia and posterior ocular segment disease in mammals, raising concerns about the human retinal microvascular involvement in SARS-CoV-2. OBJECTIVE: To objectively assess the presence of retinal microvascular impairment in COVID-19 patients by optical coherence tomography angiography (OCTA), so as to facilitate the clinical system management of COVID-19 patients. METHODS: We searched PubMed, Cochrane Library, EMBASE, Ovid, CBM to collect eligible studies. The main outcomes included the vessel density (VD), area or perimeter of foveal avascular zone (FAZ), central foveal thickness (CFT), subfoveal choroidal thickness (SCT) in our meta-analysis. RESULTS: We eventually included five studies with a total of 401 participants. Our meta-analysis showed that nonacute infectious COVID-19 or post-COVID-19 patients presented significantly lower foveal VD of deep capillary plexus (WMD = -4.22, 95% CI [-8.00, -0.43]) and thinner SCT (WMD = -10.33, 95% CI [-19.08, -1.57]) than healthy controls. The foveal VD and parafoveal VD of superficial capillary plexus, parafoveal VD of deep capillary plexus, CFT, area, and perimeter of FAZ showed no significant differences between the groups. CONCLUSION: The patients of nonacute infectious COVID-19 or post-COVID-19 displayed alterations in the retinal microvasculature and choroidal vessels, including a significantly lower foveal VD in deep capillary plexus and thinner SCT. The impairment may be a medium to long-term process. Close ophthalmic surveillance is necessary for COVID-19 patients or post-COVID-19 patients.


Subject(s)
COVID-19 , Retinal Vessels , Fluorescein Angiography/methods , Humans , Retina/diagnostic imaging , Retinal Vessels/diagnostic imaging , SARS-CoV-2
4.
Indian J Ophthalmol ; 70(5): 1780-1786, 2022 05.
Article in English | MEDLINE | ID: covidwho-1835158

ABSTRACT

Purpose: To evaluate the retinal microvascular changes in patients, recovered from severe COVID-19 during the second wave of the pandemic in North India. Methods: In this observational cross-sectional study, 70 eyes of 35 patients who recovered from severe COVID-19 during the second wave underwent detailed ophthalmic evaluation 4-6 weeks after discharge. Twelve controls were also enrolled, and the difference in the findings between the case and control groups on optical coherence tomography (OCTA) were studied. Result: The ages of study participants ranged from 27 to 60 years with the male:female ratio being 1.05:1. The fundus changes suggestive of ischemia in the form of cotton wool spots and vascular tortuosity were seen in 25 eyes (35.71%). Increased venous tortuosity was the most common finding seen in 23 eyes (32.85%), of which 10 eyes (28.57%) had concurrent hypertensive retinopathy (HTR) changes. There was a significant reduction in the mean vascular density (VD) and perfusion density (PD) for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at inner, outer ring, and whole (P < 0.05). Foveal avascular zone was significantly enlarged in both the SCP (P = 0.01) and the DCP (P = 0.03). The mean ganglion cell-inner plexiform layer (GC-IPL) was significantly reduced in comparison to controls (P < 0.001). Conclusion: Severe COVID-19 can result in microvascular changes at the macula in the form of reduction in vascular and perfusion density, which can be evaluated using OCTA. As structural changes precede functional changes, a close watch is recommended in patients showing compromise in retinal microvasculature.


Subject(s)
COVID-19 , Macula Lutea , Adult , COVID-19/complications , COVID-19/epidemiology , Female , Fluorescein Angiography/methods , Humans , Male , Middle Aged , Retinal Vessels/diagnostic imaging , Tomography, Optical Coherence/methods
5.
BMJ Case Rep ; 15(5)2022 May 10.
Article in English | MEDLINE | ID: covidwho-1832380

ABSTRACT

We report a case of Susac syndrome after SARS-CoV-2 infection and subsequent vaccination that presented with meningitis and retinal microembolisation in the form of paracentral acute middle maculopathy (PAMM). After presenting with headache, fever and myalgia followed by scotomata, a woman in her 50s was hospitalised for meningitis; she had had mild COVID-19 infection 2 months prior to admission, having received the first vaccine dose 1 month prior to the neurological manifestation. Eye fundus examination and optical coherence tomography were suggestive of PAMM. D-dimer levels and erythrocyte sedimentation rate were elevated. Before infectious investigation results were available, she was started on empirical antibiotic and antiviral treatment. Having ruled out infectious causes, she was started on high-dose prednisolone. After 1 month, there was partial resolution of retinal lesions. This case highlights that exposure to SARS-CoV-2 antigen may be related to this rare syndrome; treatment with steroids may improve central and retinal impairment.


Subject(s)
COVID-19 , Macular Degeneration , Retinal Diseases , Susac Syndrome , Female , Fluorescein Angiography/methods , Humans , Macular Degeneration/complications , Retinal Diseases/diagnosis , Retinal Diseases/drug therapy , Retinal Diseases/etiology , Retinal Vessels/pathology , SARS-CoV-2 , Tomography, Optical Coherence/methods
6.
BMJ Open Ophthalmol ; 7(1): e000867, 2022.
Article in English | MEDLINE | ID: covidwho-1807429

ABSTRACT

OBJECTIVE: This study aims to analyse the possible recovery or worsening in retinal microvasculature after 8 months in a previously studied COVID-19 cohort. METHODS AND ANALYSIS: A cross-sectional case-control study and a prospective longitudinal cohort study. Participants were the subjects of our previous study who re-enrolled for a new examination including a fundus photograph (retinography), an optical coherence tomography (OCT) scan and an OCT angiography. COVID-19 diagnosed patients were divided into three groups: group 1: mild disease, asymptomatic/paucisymptomatic subjects who received outpatient care; group 2: moderate disease and group 3: severe disease, both of which required hospital admission because of pneumonia. Statistical analyses were performed using SPSS software (V.23.0). Cross-sectional intergroup differences were analysed by means of analysis of variance for normally distributed variables and the Kruskal-Wallis test for non-normally distributed ones. In reference to the prospective part of the study (intragroup differences, baseline with 8-month comparison), a paired t-test was used for normally distributed data and Wilcoxon signed ranks sum for non-normally distributed data. RESULTS: The fovea-centered superficial and deep vascular densities were significantly diminished in severe cases compared with mild cases (p=0.004; p=0.003, respectively, for superficial and deep) and to controls (p=0.014; p=0.010), also in moderate cases to mild group (p=0.004; p=0.003) and to controls (p=0.012; p=0.024). In the longitudinal study, no significant statistical differences were found between baseline and 8-month follow-up vessel density values. CONCLUSION: We demonstrated persistent reduction in the central vascular area over time in patients with moderate and severe COVID-19.


Subject(s)
COVID-19 , Case-Control Studies , Cross-Sectional Studies , Fluorescein Angiography/methods , Humans , Longitudinal Studies , Prospective Studies , Tomography, Optical Coherence/methods
7.
J Glaucoma ; 31(6): 399-405, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1758887

ABSTRACT

PRCIS: Face mask wearing has no significant effects on artifacts or vessel density measurements in optic nerve head (ONH) and macular optical coherence tomography-angiography (OCT-A) scans. PURPOSE: The aim was to assess the difference in area of artifacts observed in optical OCT-A scans with and without face mask wear and to verify if mask wear interferes with OCT-A vessel density measurements. SUBJECTS AND CONTROLS: A total of 64 eyes of 10 healthy subjects, 4 ocular hypertensive, 8 glaucoma suspects, and 17 glaucoma patients were included. MATERIALS AND METHODS: High-density ONH and macula OCT-A scans were obtained in patients with and without surgical masks. Seven different artifacts (motion, decentration, defocus, shadow, segmentation failure, blink, and Z-offset) were quantitatively evaluated by 2 trained graders. The changes in the area (% of scan area) of artifacts, without and with mask wearing, and differences of vessel density were evaluated. RESULTS: Trends of increasing motion artifact area for the ONH scans [4.23 (-0.52, 8.98) %, P=0.08] and defocus artifact area for the macular scans [1.06 (-0.14, 2.26) %, P=0.08] were found with face mask wear. However, there were no significant differences in the mean % area of any artifacts (P>0.05 for all). Further, the estimated mean difference in vessel density in images acquired without and with masks was not significant for any type of artifact. CONCLUSION: Face mask wearing had no significant effect on area of artifacts or vessel density measurements. OCT-A vessel density measurements can be acquired reliably with face mask wear during the pandemic.


Subject(s)
COVID-19 , Glaucoma , Angiography/methods , Artifacts , COVID-19/epidemiology , Fluorescein Angiography/methods , Humans , Intraocular Pressure , Masks , Pandemics , Retinal Vessels , Tomography, Optical Coherence/methods
8.
Graefes Arch Clin Exp Ophthalmol ; 260(8): 2687-2693, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1750706

ABSTRACT

PURPOSE: To examine retinal and corneal neurodegenerative and retinal microvascular changes in patients after mild or asymptomatic COVID-19 disease compared to age-matched controls. METHODS: Thirty-five (35) patients after PCR-proven SARS-CoV-2 infection and 28 age-matched controls were enrolled. Swept-source optical coherence tomography (OCT), OCT angiography, and in vivo corneal confocal microscopy were performed in both groups. Corneal subbasal nerve plexus was quantified. Vessel density for superficial (SCP) and deep capillary plexus (DCP) and structural OCT parameters were recorded. RESULTS: Significantly lower nerve branch density (P = 0.0004), nerve fiber area (P = 0.0001), nerve fiber density (P = 0.0009), nerve fiber length (P < 0.0001), and total nerve branch density (P = 0.002) values were observed in patients after COVID-19 compared to healthy controls. VD of the temporal SCP was significantly different between the two groups (P = 0.019). No other SCP and DCP vessel density parameter differed significantly between the two groups. CONCLUSIONS: Our results suggest that peripheral neurodegenerative changes may occur even after mild or asymptomatic SARS-CoV-2 infection. No relevant microvascular changes were seen with OCT angiography and structural OCT parameters did not show any signs of optic neuropathy in post-COVID patients. In vivo confocal microscopy seems to be an important tool in monitoring peripheral neuropathy in patients after COVID-19.


Subject(s)
COVID-19 , Retinal Vessels , COVID-19/complications , COVID-19/diagnosis , Fluorescein Angiography/methods , Humans , SARS-CoV-2 , Tomography, Optical Coherence/methods
9.
Arq Bras Oftalmol ; 85(2): 158-165, 2022.
Article in English | MEDLINE | ID: covidwho-1744710

ABSTRACT

PURPOSE: The primary purpose of this study was to assess vascular retinal findings temporally related to COVID-19 vaccination. With greater information regarding all possible future adverse events, we hope to understand the real dimension and relevance of what was presented. METHODS: Eleven patients with visual complaints after COVID-19 vaccination were enrolled. Data on the following were included: age, sex, vaccine, time of symptom onset, systemic findings, medical history, best-corrected visual acuity, and ocular findings by slit-lamp biomicroscopy as well as multimodal retinal imaging (color fundus, red-free photography, spectral-domain optical coherence tomography, optical coherence tomography angiography, and fluorescein-angiography). Inclusion criteria were the presence of ophthalmologic signs within 30 days after the first or second dose of any COVID-19 vaccine. RESULTS: Of 11 patients, five had arterial occlusion (45.4%), four had venous occlusion (36.4%), and two (18.2%) had nonspecific vascular alterations suggestive of retinal ischemia such as cotton-wool spots. The mean age was 57 (SD = 16; range: 27-84) years. The mean time of symptoms onset was 10 (SD = 5.4; range: 3-16) days. Nine patients were female (81.8%). Systemic risk factors were observed in 36.4% of patients. Two patients had both neurological and visual symptoms, with arterial occlusion. Overall, 36.4% patients had COVID-19 in the previous year. Seven patients (63.6%) received ChAdOx1 nCoV-19 (AZD1222) vaccine. CONCLUSIONS: Our data suggest that retinal events temporally related to COVID-19 vaccination are possible but are very rare. The relationship of these events with post-COVID-19 vaccination warrants further attention to derive a meaningful conclusion.


Subject(s)
COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Fluorescein Angiography/methods , Humans , Male , Middle Aged , Tomography, Optical Coherence/methods , Vaccination/adverse effects
10.
Arq Bras Oftalmol ; 85(2): 186-189, 2022.
Article in English | MEDLINE | ID: covidwho-1742904

ABSTRACT

A 38-year-old woman presented with photopsias and progressive but painless loss of vision in her right eye. Of note, she had received the first dose of inactivated COVID-19 vaccine (Sinovac/China National Pharmaceutical Group) 2 weeks prior to the onset of symptoms. Ophthalmic evaluation revealed a wreath-like foveal pattern and multiple gray-white dots throughout the posterior pole associated with discrete vitreous inflammatory reaction. Multimodal imaging analysis confirmed a diagnosis of multiple evanescent white dot syndrome. The patient underwent treatment with corticosteroids and, over the following weeks, her visual acuity improved to standard pattern.


Subject(s)
COVID-19 , Retinal Diseases , White Dot Syndromes , Adult , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Fluorescein Angiography/methods , Humans , Retinal Diseases/diagnosis , Vaccination
12.
Graefes Arch Clin Exp Ophthalmol ; 260(3): 771-779, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1460330

ABSTRACT

BACKGROUND/AIMS: To quantify the longitudinal changes of the macular microvasculature and the foveal avascular zone (FAZ) parameters in patients recovered from coronavirus disease-2019 (COVID-19) using optical coherence tomography angiography (OCTA) analysis. METHODS: This observational, longitudinal study was performed on patients recovered from COVID-19. The OCTA images were recorded at baseline and after 1 and 3 months at the follow-up examination. Vessel density (VD) of the retinal superficial (SCP) and deep capillary plexus (DCP), as well as the area of the FAZ of patients who had recovered from COVID-19, were measured. RESULTS: In total, 36 eyes of 18 patients (62.2% female) with a mean age of 34.5 ± 7.5 years old were included. Regarding SCP, while the VDs of the whole image, fovea, and parafovea were comparable at different time points, the mean VDs in inferior hemifield, as well as superior and inferior regions of perifovea, underwent significant reductions at month 3, compared to the baseline. In DCP, the mean of VD in the whole image was 54.3 ± 2.7 at the first visit which significantly decreased to 52.1 ± 3.8(P = 0.003) and 51.4 ± 2.7(P = 0.001) after 1 and 3 months, respectively. The VDs in all regions of parafovea and perifovea revealed a significant reduction after 1 and 3 months, compared to the first visit. The mean FAZ area was 0.27 ± 0.08 mm2, 0.26 ± 0.08 mm2, and 0.27 ± 0.08 mm2 at the baseline, month 1, and month 3, respectively (P > 0.05). CONCLUSION: Based on the results, the patients who had recovered from COVID-19 had a progressive decrease of VD at the follow-up visit 3 months after COVID-19 infection.


Subject(s)
COVID-19 , Tomography, Optical Coherence , Adult , Female , Fluorescein Angiography/methods , Humans , Longitudinal Studies , Male , Retinal Vessels/diagnostic imaging , SARS-CoV-2 , Tomography, Optical Coherence/methods
13.
Am J Ophthalmol ; 235: 98-110, 2022 03.
Article in English | MEDLINE | ID: covidwho-1442222

ABSTRACT

PURPOSE: To evaluate the occurrence of retinal microvasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who developed coronavirus disease (COVID-19). DESIGN: Systematic review and meta-analysis. METHODS: The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analyzed in RevMan Web versions 3.3. Quality of evidence was assessed using the National Institute of Health quality assessment tool for a case-control study. RESULTS: Thirty-one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case-control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal microvasculopathy in subjects with COVID-19 compared to controls (odds ratio [95% confidence interval], 8.86 [2.54-27.53], P < .01). Optical coherence tomography angiography (OCTA) revealed reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls. CONCLUSIONS: The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might have occurred antecedent to clinically visible changes and could be detected earlier by OCTA. These findings are significant, due to the large numbers with COVID-19, and need to be recognized by ophthalmologists as a potential long-term sequalae of the disease.


Subject(s)
COVID-19 , Case-Control Studies , Fluorescein Angiography/methods , Fundus Oculi , Humans , Retinal Vessels/diagnostic imaging , SARS-CoV-2 , Tomography, Optical Coherence/methods
14.
Klin Monbl Augenheilkd ; 239(3): 284-287, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1412513

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.


Subject(s)
COVID-19 , Adolescent , Adult , Aged , COVID-19/complications , Diagnostic Techniques, Ophthalmological , Fluorescein Angiography/methods , Humans , Male , Middle Aged , Photography/methods , Retina/diagnostic imaging , Retina/pathology , Tomography, Optical Coherence/methods , Young Adult
15.
Ocul Immunol Inflamm ; 29(4): 642-644, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1369009

ABSTRACT

Purpose: Coronavirus Disease 2019 (COVID-19) can cause conjunctivitis in up to 31.6% of patients. Additionally, retinal findings compatible with retinal microvascular ischemia have also been associated with coronavirus disease in asymptomatic patients. We describe a case of bilateral retinal changes compatible with microangiopathy occurring during the late phase of COVID-19.Case report: A 50-year-old man with bilateral pneumonia and positive polymerase chain reaction for SARS-CoV-2 developed an arcuate visual field defect in his left eye. Funduscopy revealed multiple, bilateral cotton-wool spots without haemorraghes. OCT-angiography revealed multifocal areas of retinal microvascular ischemia in the superficial plexus, the largest of which corresponded to the arcuate scotoma observed in the automated perimetry.Conclusion: Visual field defects due to retinal microangiopathy can occur during the late phase of COVID-19. Vascular changes observed in the retina may mimic what may be happening in other, less-accessible organs.


Subject(s)
COVID-19/complications , Capillaries/pathology , Retinal Diseases/etiology , Retinal Vessels/pathology , Fluorescein Angiography/methods , Fundus Oculi , Humans , Male , Middle Aged , Ophthalmoscopy , RNA, Viral/analysis , Retinal Diseases/diagnosis , SARS-CoV-2/genetics , Tomography, Optical Coherence/methods
16.
Ocul Immunol Inflamm ; 29(4): 730-733, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1287901

ABSTRACT

Purpose: To report acute macular neuroretinopathy (AMN) in two young women two days after receiving Vaxzevria Coronavirus disease (COVID-19) vaccination.Methods: Observational case reports.Observation: The first patient was an Italian 22-year-old female with acute onset of paracentral scotoma two days post vaccination. The second patient was an Austrian 28-year-old female who presented with sudden onset paracentral scotoma two days after vaccination. Multimodal retinal imaging was consistent with AMN in both cases. Both patients were on long-term oral contraceptives, had no history of COVID-19 and experienced one-day duration fever the day after the vaccination.Conclusions: Vaccination may represent a possible risk factor for AMN onset in women on oral contraceptives. We encourage ophthalmologists to investigate recent vaccination status when dealing with new onset AMN. Further studies are needed to assess the link between vaccinations and AMN.


Subject(s)
COVID-19 Vaccines/adverse effects , Retinal Vessels/diagnostic imaging , Vaccination/adverse effects , Visual Acuity , White Dot Syndromes/etiology , Adult , COVID-19 , Female , Fluorescein Angiography/methods , Fundus Oculi , Humans , SARS-CoV-2 , Tomography, Optical Coherence/methods , White Dot Syndromes/diagnosis
17.
Ocul Immunol Inflamm ; 29(4): 675-676, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1185530

ABSTRACT

Background: To describe the first case of Coronavirus disease-2019 (COVID-19) vision loss from an acute outer retinopathy.Methods: A retrospective case report from a tertiary referral center using multimodal retinal imaging and clinical examination findingsFindings: A 40-year-old female developed significant vision loss in her right eye shortly after developing fever and myalgias. She was found to be COVID positive, while her systemic laboratory evaluation was otherwise unremarkable. Multimodal imaging was consistent with a white-dot-like outer retinopathy and she was started on systemic prednisone. Within 10 days of starting steroids, her vision, symptoms, and outer retinal changes on multimodal imaging were improving.Interpretation: While exceedingly rare, COVID-19 can cause inflammatory-associated changes of the outer retina and significant vision loss.


Subject(s)
COVID-19/complications , Fluorescein Angiography/methods , Retina/pathology , Retinal Diseases/etiology , SARS-CoV-2 , Tomography, Optical Coherence/methods , Adult , Female , Fundus Oculi , Humans , Retinal Diseases/diagnosis , Visual Acuity
18.
Ocul Immunol Inflamm ; 29(4): 671-674, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1185529

ABSTRACT

Purpose: Coronavirus-19 disease (COVID-19) has been associated with a high risk of thrombotic complications. Here, we report the case of a patient who developed simultaneous bilateral retinal artery occlusion following COVID-19 infection.Case Report: A 42-year-old male with no systemic co-morbidities presented with sudden, painless loss of vision in both eyes. Fundoscopy showed retinal edema and cherry-red spots in both eyes. Fluorescein angiography showed reperfusion, absence of choroidal ischemia, and Optical Coherence Tomography showed thickened inner retinal layers suggestive of retinal edema and the outer retinal layers appeared intact. Blood investigations for vasculitis, coagulation profile, lipids, and homocysteine level were within normal limits.Conclusion: COVID-19 patients may develop a systemic coagulopathy and acquired thrombophilia characterized by a tendency for venous, arterial, and microvascular thrombosis. This hypercoagulable state is believed to be a hyperinflammatory response; physicians and ophthalmologists, alike, should be aware of these possible long-term sequelae.


Subject(s)
COVID-19/complications , Fluorescein Angiography/methods , Retinal Artery Occlusion/etiology , Retinal Vessels/pathology , SARS-CoV-2 , Tomography, Optical Coherence/methods , Visual Acuity , Adult , Fundus Oculi , Humans , Male , Retinal Artery Occlusion/diagnosis
19.
Ocul Immunol Inflamm ; 29(4): 677-680, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1172599

ABSTRACT

Purpose: Herein, we report a case of bilateral neuroretinitis and panuveitis in a patient recovered from coronavirus disease 2019 (COVID-19).Case presentation: A 37-year-old male patient with a history of recovered COVID-19, which was confirmed with nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), about one-month ago was referred with one-week history of bilateral severe vision loss. Visual acuity was counting fingers, and bilateral retinitis and panuveitis were revealed in ocular examination. The result of the vitreous sample using RT-PCR was positive for SARS-CoV-2 and negative for Herpesviridae viruses and mycobacterium tuberculosis. The patient was successfully treated with corticosteroid.Conclusion: We report a case of bilateral neuroretinitis and panuveitisin a recovered COVID-19 patient and positive RT-PCR of the vitreous sample. It is suggested to apply intraocular sampling and evaluation for COVID-19 in patients with the new-onset of uveitis and/or retinitis during the pandemic.


Subject(s)
COVID-19/complications , Eye Infections, Viral/etiology , Panuveitis/etiology , RNA, Viral/analysis , Retinitis/etiology , SARS-CoV-2/genetics , Visual Acuity , Adult , COVID-19/epidemiology , Eye Infections, Viral/diagnosis , Eye Infections, Viral/virology , Fluorescein Angiography/methods , Fundus Oculi , Humans , Male , Pandemics , Panuveitis/diagnosis , Panuveitis/virology , Retina/pathology , Retinitis/diagnosis , Retinitis/virology , Tomography, Optical Coherence/methods , Uvea/pathology
20.
Am J Ophthalmol ; 227: 182-190, 2021 07.
Article in English | MEDLINE | ID: covidwho-1157088

ABSTRACT

PURPOSE: This study investigated changes in retinal vessel density 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 years old) 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 resulted from OCTA studies of the following vascular structures: vessel density (VD) in the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and radial peripapillary capillaries (RPC) compared to those of controls. Structural spectral domain (SD)-OCT parameters were also evaluated: ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL). RESULTS: The patients showed a significant reduction in VD of the SCP in whole images and in the DCP in all sectors compared to those in healthy subjects (P <.05). COVID-19 patients featured a reduced VD of the RPC compared to that in controls (P <.001). No differences were found in the GCC, whereas the RNFL was reduced in the COVID-19 group compared to that in controls (P = .012). Significant correlations were found between the RNFL and VD of the SCP, DCP, RPC, and FAZ area in the COVID-19 group (P <.05). CONCLUSIONS: 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, noninvasive biomarker of early vascular dysfunction after SARS-CoV-2 infection.


Subject(s)
COVID-19/epidemiology , Fluorescein Angiography/methods , Macula Lutea/pathology , Retinal Diseases/diagnosis , Retinal Vessels/diagnostic imaging , Tomography, Optical Coherence/methods , Capillaries/diagnostic imaging , Comorbidity , Female , Fundus Oculi , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Retinal Diseases/epidemiology , SARS-CoV-2
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