Paracentral acute middle maculopathy in the setting of central retinal artery occlusion following COVID-19 diagnosis.

BACKGROUND: Since its emergence in Wuhan, China, COVID-19 has disseminated across many other countries worldwide. In this report, we firstly presented a patient with mild COVID-19 disease who developed paracentral acute middle maculopathy (PAMM) due to CRAO. CASE PRESENTATION: A 54-year-old male patient who reported a contact with a COVID-19 patient applied to the hospital and tested positive for SARS-CoV-2 by polimerase chain reaction testing. He had no significant past medical history. Chest computed tomography was not notable. He had a mild COVID-19 course during hospitalization. Two weeks following COVID-19 diagnosis, he reported profund vision loss (counting fingers) in his right eye where central retinal artery occlusion (CRAO) was detected on fundoscopic examination. Coagulation profile was within normal limits. Hypercoagulable work up was also not notable. Treatment was given for CRAO. Visual acuity was counting fingers at 30 cm. Five days following treatment. Optical coherence tomography analysis showed increased diffuse reflectance and thickening at the level of inner nuclear layer consistent with PAMM. Fluorescein angiography illustrated no perfusion defect. CONCLUSION: This is the first case that reports PAMM in the setting of CRAO following COVID-19 diagnosis. Viral induced microangiopathy may involve in the development of CRAO in our patient without a hypercoagulable state and additional risk factors. Physicians should be vigilant to seek for retinal evaluation in patients with significant visual loss even after a mild COVID-19 history.

Psychopharmacological Signatures in the Retina in Schizophrenia and Bipolar Disorder: An Optic Coherence Tomography Study.

BACKGROUND: Retina is considered as a window to the brain due to the similarities in terms of development and pathologies. Optical coherence tomography (OCT) can perform quantitative examinations in the retina. In this study, we aimed to investigate the effects of drugs used in schizophrenia and bipolar disorder (BD) on retinal nerve fiber layer (RNFL) and macular thickness. SUBJECTS AND METHODS: The study included schizophrenia (n=35) and euthymic BD (n=46) patients on various medications, and age, gender matched healthy control group (n=31). For retinal evaluation, measurements of RNFL and macula were performed with Optovue RTVue Premier OCT. RESULTS: In the schizophrenia group, chlorpromazine equivalent dose of antipsychotics was a statistically significant negative predictor of left RNFL nasal superior region thickness. In the BD group, serum valproate level was a significant positive predictor of thickness in the right macular inferior outer, left macular nasal outer region, right RNFL inferotemporal, left temporal and inferotemporal regions. CONCLUSION: Since the retina consists of neurons, morphological or functional examination of retina may be beneficial for the evaluation of the effects of psychopharmalogical treatments in schizophrenia and BD. The outcome of this study implies that valproate has neuroprotective effects on the optic nerve and macula, and this finding is consistent with the literature implying neurotrophic effects of valproate.