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

Abstract

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.

Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination

“…Alessandro et al [ 13 ] reported a case of central retinal vein occlusion 2 days after the COVID-19 diagnosis. Neslihan et al [ 14 ] reported a case of central retinal artery occlusion (CRAO) and paracentral acute middle maculopathy 2 weeks after COVID-19 diagnosis. Andrea et al [ 15 ] reported a case of Central retinal vein occlusion after hospitalization for COVID-19 pneumonia.…”

Hemi- and Central Retinal Vein Occlusion Associated with COVID-19 Infection in Young Patients without Known Risk Factors

“…Various authors have described retinal vascular occlusions, including CRAO, BRVOs, and CRVOs in association with COVID-19 ( Table 2 ). 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 The present report is the first and largest case series of CRVO and HRVO occurring after COVID-19. It nearly doubles the currently published cases in the literature and is the only one to exclude predisposing risk factors.…”

“…Reported ocular manifestations in the literature to date include conjunctivitis, 10 retinal microangiopathy, 11 , 12 , 13 , 14 , 15 , 16 , 17 paracentral acute middle maculopathy, acute macular neuroretinopathy, 18 uveitis, 19 , 20 and optic neuropathy. 19 , 20 , 21 Additionally, multiple reports describing retinal vascular events such as central retinal artery occlusions, 22 , 23 , 24 , 25 branch retinal vein occlusions (BRVO), 26 , 27 hemiretinal vein occlusion (HRVO) and central retinal vein occlusion (CRVO), 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 and papillophlebitis, 37 following a diagnosis of COVID-19 have been published. The series presented herein expands on the literature and aims to highlight a potential temporal association between COVID-19 infection and the development of retinal vein occlusions (RVO) in otherwise young, healthy patients without other risk factors for RVO.…”

Inner retinal layer ischemia and vision loss after COVID-19 infection: A case report

“…COVID-19 infection causes vascular occlusion by causing endothelial damage or increasing systemic thrombotic factors [3] . Retinal artery occlusion, PAMM and acute macular neuro-retinopathy cases associated with COVID-19 have also been reported in the literature [ 4 , 5 , 6 , 7 ].…”