Macular vessel density in patients recovered from COVID 19

Abstract

Purpose The purpose is to evaluate macular vascular densities (VDs) using optical coherence tomography angiography (OCTA) in patients affected by coronavirus disease-2019 (COVID-19). Methods The superficial (SF) and deep macular VD of 50 patients with SARS CoV2 pneumonia who had positive polymerase chain reaction (PCR) tests and who recovered after receiving treatment and 55 healthy age- and gender-matched controls were compared using OCTA. Blood inflammation parameters were also recorded. Results There was no statistically significant difference between the two groups in terms of age and gender (p = 0.147 and p = 0.504, respectively). Nor was there a difference with respect to smokers between the two groups (p = 0.231). In COVID-19 patients, the VDs in superior hemi quadrant, superior quadrant and inferior quadrant, were significantly lower (p = 0.033, p = 0.029 and p = 0.042, respectively) in superficial plexus. It was also significantly lower in parafovea, superior hemi and superior quadrants (p = 0.026, p < 0.001 and p = 0.004, respectively) in deep plexus. In addition, white blood cell and neutrophil counts were significantly negatively correlated with the VD of the deep parafovea, deep superior quadrant and deep superior hemi quadrant (p < 0.05). There was no difference between the patient and control groups in both superficial and deep foveal avascular zone (FAZ) (p = 0.101 and p = 0.691 respectively) Conclusion In COVID-19 disease, VD is low in some sectors in both SF and deep layers, but no change in FAZ. The effect of COVID 19 disease on the retina and whether it makes the retina sensitive to damage can only be understood with long-term follow-up.

COVID-19-Related Retinal Micro-vasculopathy – A Review of Current Evidence

“…Among cases-control studies and case series, 18 publications (10 case-control studies [17][18][19][20][21][22][23][24][25]30 and 9 case series 13,28,29,[31][32][33][34][35][36] ) reported on the presence or absence of retinal signs related to micro-vasculopathy. Among the 10 case-control studies, retinal signs were reported in 6, with frequency ranging from 0.01% to 20%.…”

“…In addition to the reduction in VD on OCTA reported by Zapata et al, Guemes-Villahoz et al, Gonzalez-Zamora et al and Cennamo et al 18,19,25,30 , three other case-control studies compared OCTA findings between COVID-19 patients to controls but did not evaluate fundus microvascular signs. 17,20,24 Hazar et al compared 50 COVID-19 patients with mild to moderate pneumonia with 50 controls (age 37.00 vs 35.14 years, p=0.147, respectively). Eye examination was performed one month after discharge and recovery.…”

“…However, since the initial report by Marinho, several case-control studies have reported retinal features in patients with COVID-19 infection of various severity. [17][18][19][20][21][22][23][24][25] In addition to clinical features, several OCT angiography (OCTA) studies demonstrated reduction in vessel density (VD) in COVID patients, which corroborated with the possibility of COVID-19 related retinal micro-vasculopathy. [17][18][19][20][23][24][25][26] Importantly, these perfusion deficits have been detected in asymptomatic individuals with no significant medical comorbidities who have recovered from seemingly mild COVID infections.…”

“…[17][18][19][20][21][22][23][24][25] In addition to clinical features, several OCT angiography (OCTA) studies demonstrated reduction in vessel density (VD) in COVID patients, which corroborated with the possibility of COVID-19 related retinal micro-vasculopathy. [17][18][19][20][23][24][25][26] Importantly, these perfusion deficits have been detected in asymptomatic individuals with no significant medical comorbidities who have recovered from seemingly mild COVID infections. Therefore, understanding of the prevalence and progression pattern of such perfusion deficits may have significant public health implications in the long term.…”

Retinal OCT Findings in Patients after COVID Infection

“…For several years, it has been possible to visualize retinal and choroidal vasculature, without the use of contrast, due to the development of OCT angiography [ 6 , 7 ]. Recently, scientific reports have been published describing abnormalities such as an increase in RNFLT, retinal vessel enlargement, and lower vessel density of the superficial and deep retinal capillary plexus in patients after SARS-CoV-2 infection compared to a control group [ 4 , 8 , 9 , 10 ]. This study aimed to assess the presence of possible ophthalmological complications after symptomatic coronavirus disease 2019 by appraising the morphology and morphometry of the optic nerve, retina, and retinal vessels using optical coherence tomography in a group of post-COVID-19 subjects.…”