Author: Nerea Zubieta (Spain)
Co-authors: Sandra Pérez-García, Henar Heras-Mulero, Santiago López-Arbués, Gonzalo Guerrero-Pérez, Iñigo Salmerón-Garmendia, Araceli Alcaine-Soler
Purpose
We report a case of a 63-year-old male patient, that came to the emergency room complaining of a decrease of visual acuity and central scotoma in his left eye. He had had flu-like symptoms for a week. The test was positive for COVID infection, and he was diagnosed with retinal pigment epitheliitis, after the patient having undergone a full ophthalmological examination. Besides, a VI-nerve palsy was diagnosed. We would like to emphazise the variety of symptoms this still not well-known COVID infection can cause, and explore how this virus might be related with retinal pathologies.
Setting/Venue
We would like to emphazise the variety of symptoms this still not well-known COVID infection can cause, and explore how this virus might be related with retinal pathologies.
Methods
Acute retinal pigment epitheliitis might be a cause on sudden vision loss and central scotoma, that usually affects young adults, and curses with a good visual prognosis. Even though the mechanisms that are related to this illness are not still perfectly defined, it may be caused as a result of the RPE being damaged by an inflammatory response, that might be caused after a viral infection. COVID-19 is a threaning virus, whose effects are still being discovered and studied everytime we see patients where the infection of this virus and certain pathologies coexist. Apart from attacking the lungs, it is thought to be responsible for having thrombotic effects in several tissues, the retina for instance.
Results
We report the case of a 63-year-old male with a 7 day-period decrease of visual acuity in his left eye, due to a central scotoma. He had been recently diagnosed with type-2 diabetes. He had had had flu-like symptoms (headache, asthenia) since the very beginning of the visual acuity loss. The visual acuity (VA) in his left eye was 1/10, and a large-angle esotropia could be noticed due to a VI-nerve palsy in that eye. No anterior chamber inflammation could be detected. The optic disc did not show pallor nor swelling. The retinal findings in the left eye showed a macular lesion with granular RPE disruption pattern and satelite lesions. The SD-OCT confirmed a disruption on the ellipsoid-RPE layer, affecting the fovea. Oral high doses of steroids were prescribed to tackle the visual impairment. Additionally, as a part of the protocole, he was tested with COVID PCR, which dropped a positive result. FA and ICGA revealed hyperfluorescent patchy macular areas.The visual acuity improved over the mentioned period, reaching up to 5/10 after three months. By this time, although the anatomical findings had dramatically improved, the RPE inner layer remained still slightly disrupted, which could explain the incomplete visual acuity recovery.
Conlusions
Acute retinal pigment epitheliitis (ARPE) is a cause of acute decreased vision. It normally affects young adults and has a good visual prognosis,though there is literature reporting a 11% of the patients with persistent disruption of external retinal layers.The RPE and photoreceptors are the main tissues to be involved on this illness.ARPE might occur after a viral infection; a crossed immune reaction towards retina, RPE or choriocapillaris might produce local inflammation, and therefore damage the mentioned tissues.Corticosteroid therapy, may have a positive effect on controlling this local inflamation, and thus, providing a better visual recovery. We report a case of a ARPE with certain particularities, such as the patient being quite older than what is usually expected, incomplete VA recovery, and a coexistent COVID-19 infection. COVID-19 is an emergent virus whose pathogenesis remains still not fully understood. It might altere tissues’ blood circulation by thrombotic mechanisms and might as well cause local inflammation. As the choriocapillaris is involved in ARPE, blood-flood on this layer might be altered, due to the two mechanisms proposed above, secondary causing this illness in a context of a COVID infection. Still new studies need to be carried away in order to elucidate the precise proccess.
Financial Disclosure
I do not have any financial relations.
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