Author: Nuria Torrell Belzach (Spain)
Co-authors: Francisca Bassaganyas Vilarrasa, José Ignacio Vela Segarra, Jesús Díaz Cascajosa, Jaume Crespí Vilimelis, Alicia López de Eguileta, Mohammed Alhayek
Purpose
To describe a case series of young patients who presented ischemic retinal vascular occlusion using multimodal imaging. They had recently been diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction (PCR) test after nasopharyngeal swab.
Setting/Venue
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Methods
Case series of 3 patients with less than 59 years old (range 42 to 58, mean 51 years old) recently diagnosed with non-severe coronavirus disease-19 (COVID-19) who presented to the medical retina unit in a tertiary hospital in Barcelona between October 2020 and March 2021. All patients underwent complete systemic and ophthalmic evaluation, including blood pressure, blood test (hemogram, lipid profile, HbA1c, coagulation profile, vasculitis screening), best corrected visual acuity (BCVA), fundoscopy, wide field retinal imaging with fluorescence angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A).
Results
This study includes 2 females and 1 male without any relevant previous pathology, except one who had type 2 diabetes mellitus with adequate glycaemic control and without previous signs of diabetic retinopathy. No other cardiovascular risk factors were associated in any of the patients. All three patients had important visual impairment of one eye at presentation with BCVA less than 0.5 (range of 0,1-0.4). One of them presented a superior hemiretinal vein occlusion, another a central venous occlusion (CVO) with subretinal haemorrhage and finally, the other showed an initial CVO which was posteriorly associated to paracentral acute medial maculopathy (PAMM). Only this last patient experienced BCVA improvement after intravitreal treatment, while the other two had a final BCVA less than 0.1, despite intravitreal treatment with anti-vascular endothelial growth factor (anti-VEGF) and/or dexamethasone intravitreal implant.
Conlusions
Retinal vascular occlusion is rarely found in young patients without comorbidities. It has been published that SARS-CoV-2 virus probably triggers a immune mediated inflammatory response that causes generalized endotheliitis that can ultimately lead to tissue hypoperfusion. This case series suggests that there could be a link between ischemic vascular retinal occlusion in young patients and SARS-CoV-2 recently previous infection, possibly in the form of vasculitic retinal occlusion. However, larger studies are needed to expand knowledge about this possible presentation in COVID-19. Furthermore, it should be discussed whether these retinal vascular occlusions could be avoided with anticoagulant prophylaxis, considering an adequate balance of risks and benefits. Additionally, systemic glucocorticoids could also be a treatment once retinal vascular occlusion is established.
Financial Disclosure
NONE
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