Author: Carlos Cruz
Co-authors: Keissy Sousa, Alvaro Silva, Gil Calvao-Santos, Luis Mendonca, Petra Gouveia, Gabriel Morgado
Abstract
PURPOSE: Coronavirus disease 2019 (COVID-19) is a multisystem inflammatory condition that frequently damages the vascular system – including retinal vessels – by inflammatory or thrombotic mechanisms. Ocular manifestations have been reported, starting with cases of conjunctivitis and extending the association to other pathologies such as uveitic, retinovascular, and neuro-ophthalmic disease. Ocular adverse effects have also been reported after COVID-19 vaccination. We report cases of retinal involvement in patients with previous COVID-19 diagnosis or vaccine inoculation.SETTING/VENUE: Ophthalmology Department, Hospital de Braga, Braga, Portugal
METHODS: Retrospective study including patients with newly diagnosed retinal disease and an history of recent (6-months) COVID-19 RT-PCR diagnosis (nasopharyngeal swabs) or vaccine inoculation without any concomitant ophthalmic pathology. Variables evaluated included: age, gender, past medical and ophthalmic history, COVID-19 infection severity (asymptomatic, mild with ambulatory care, or severe with hospitalization), time elapsed from COVID-19 diagnosis/vaccine inoculation to ocular symptoms/diagnosis, retinal and laboratory findings, and management.
RESULTS: We reported 8 patients with retinal pathology associated with COVID-19 infection/vaccination. Six were diagnosed with retinal vascular occlusion – 4 with Venous and 2 with Arterial Occlusion. One patient presented with Paracentral Acute Middle Maculopathy (PAMM) and 1 with Acute Macular Neuroretinopathy (AMN). Median age at diagnosis was 53,5 years-old for total sample and 56,0 for Retinal Vascular Occlusions. Median time elapsed from infection/vaccination to ocular symptoms/diagnosis was 3,0 weeks (1-24). Five patients (62,5%) had cardiovascular risk factors and 3 (37,5%) were apparently healthy. Two Venous Occlusion cases had vascular leakage in fluorescein angiography.
CONCLUSIONS: The causal relation between retinal disease and COVID-19 infection/vaccination is yet to be established with certainty. The potential inflammatory/imune mechanism for retinal involvement in these patients may change the optimal treatment choice, namely based on glucocorticoid. We believe that reporting these cases will help physicians to be vigilant and to better diagnose, refer and treat ocular disease associated with COVID-19. Further multicenter studies are needed to analyze this association.
No financial conflicts of interest to declare.
