Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection

Güemes-Villahoz, Noemí; Burgos-Blasco, Bárbara; Vidal‐Villegas, Beatriz; Donate-López, J.; Martín‐Sánchez, Francisco Javier; Porta‐Etessam, Jesús; López-Guajardo, Lorenzo; Martín, Juan Antonio González; González-Armengol, Juan Jorge; García‐Feijoó, Julián

doi:10.1016/j.medcli.2020.12.006

Cited by 24 publications

(26 citation statements)

References 19 publications

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“…COVID-19 patients reportedly have abnormal VD. A study of 31 COVID-19 patients reported reduced VD and PD values during the acute phase of disease,[ 9 , 25 , 26 , 27 ] similar to the findings in our study. The inner, outer, and full sectors, which remain outside of the centre VD and PD, were thinner.…”

Section: Discussionsupporting

confidence: 90%

“…In a study regarding D-dimer levels in adult COVID-19 patients, VD and PD levels were significantly reduced in 48 of 80 patients with D-dimer levels ≥ 500 ng/mL. [9] In our study of 19 patients, we did not find such a relationship; however, 11 of our 19 patients had D-dimer levels > 500 ng/mL, with a mean value of 898.7 ± 645.7. D-dimer levels may affect VD and PD by triggering microthrombosis.…”

Section: Discussioncontrasting

confidence: 61%

“…[ 7 , 8 ] Although some studies have reported posterior segment involvement in COVID-19 patients, such involvement mostly occurs in adults. [ 9 , 10 ] Here, we used optical coherence tomography angiography (OCTA) to examine posterior segment involvement in children with COVID-19. OCTA is a new generation of non-invasive devices, which displays blood flow with high resolution in the retina and choroid, thereby providing information regarding ischemia.…”

Section: Introductionmentioning

confidence: 99%

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Retinal microvascular and perfusional disruption in paediatric COVID-19: A case-control optical coherence tomography angiography study

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Güven

2021

Photodiagnosis and Photodynamic Therapy

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Purpose : To investigate the short-term effect of coronavirus 2019 (COVID-19) on the retinal capillary network and choroid in children. Materials and Methods : This prospective, cross-sectional, case-control study included 19 recovered COVID-19 paediatric patients and 20 healthy children. Macular thickness, choroidal thickness, vessel density (VD), perfusion density (PD), and foveal avascular zone (FAZ) values were obtained. Central vessel and perfusion densities were measured at the central 6-mm area, and the values were compared among three subgroups according to location. Results : The mean ages of patients and controls were 12.42 ± 3.3 years and 13.35 ± 1.2 years, respectively. Significant differences were observed between the two groups in terms of inner, outer, and full VD, as well as inner and full PD. No significant differences in centre VD and PD were observed between groups. Although it was not evident in analysis of choroidal values, inflammatory sites were thickened. FAZ area significantly differed between groups (p < 0.05). Conclusions : Retinal microvascularity was impaired in the acute phase of disease in recovered COVID-19 patients aged 10–15 years. However, the microvascularity impairment was subclinical. The choroid was thickened because of inflammation during the acute phase of disease. Paediatric COVID-19 patients should undergo follow up via optical coherence tomography angiography to detect subclinical retinal changes. (Clinically asymptomatic retinal changes) Long-term follow-up studies are needed to validate these findings.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Retinal microvascular and perfusional disruption in paediatric COVID-19: A case-control optical coherence tomography angiography study

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2021

Photodiagnosis and Photodynamic Therapy

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“…It should be noted that a previous study from our group reveled a decrease in macular perfusion in patients with high D-Dimer compared with COVID-19 patients who did not present increased levels. 26 This is plausible since D-Dimer has been highly linked to thrombosis. Zapata et al also found a lower fovea-centered VD in a case-control study that included patients with PCR-confirmed SARS-CoV-2 infection during the 3 months before patient’s enrollment.…”

Section: Discussionmentioning

confidence: 99%

Optic Nerve Head Vessel Density Assessment in Recovered COVID-19 Patients: A Prospective Study Using Optical Coherence Tomography Angiography

Burgos-Blasco

Güemes-Villahoz

Vidal‐Villegas

et al. 2021

Journal of Glaucoma

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Precis: Vascular diseases have been linked to alterations in optic nerve head perfusion. Purpose: The main objective was to investigate the changes in peripapillary vessel density (VD) in post coronavirus disease (COVID-19) patients. Methods: In this prospective pilot exploratory study, patients with COVID-19 that were attended in the Emergency Department of Hospital Clinico San Carlos (Madrid) were included. All patients underwent optic nerve head optical coherence tomography angiography using the Cirrus HD-OCT 500 with AngioPlex OCTA (Zeiss, Dublin, CA) 4 and 12 weeks after diagnosis by positive reverse transcriptase-polymerase chain reaction test from nasopharyngeal swab at the Emergency Department. Sociodemographic data, medical history, disease severity, and laboratory work-up were collected. Results: One hundred and eighty eyes of 90 patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection were included. None of the patients reported visual changes. Severe patients were older, more frequently hispanic, dyslipidemic, and presented lower lymphocytes counts, as well as increased ferritin, D-dimer, fibrinogen, and international normalized ratio levels. No changes in optic nerve head vascularization were observed when both visits were compared. No correlation was found between VD and clinical parameters, disease severity and laboratory work-up. Conclusions: Changes to peripapillary VD were not observed in patients with COVID-19 in the early months following diagnosis.

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“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Teo

Invernizzi

Staurenghi

et al. 2022

American Journal of Ophthalmology

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Purpose To evaluate the occurrence of retinal micro-vasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and developed coronavirus disease (COVID-19). Design Systematic review and meta-analysis. Methods The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analysed in RevMan Web versions 3.3. Quality of evidence was assessed using the National institute of health (NIH) quality assessment tool of case-control study. Results Thirty one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal micro-vasculopathy in subjects with COVID-19 compared to controls. (odds ratio [95% confidence interval], 8.86 [2.54-27.53], p<0.01). Optical coherence tomography angiography (OCTA) reveals reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls. Conclusions Our results suggested that COVID-19 related retinal micro-vasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might occurred antecedent to clinically visible changes and could be detected early by OCTA. These findings are significant due to the large numbers with COVID-19 and needs to be recognized by ophthalmologist as a potential long term sequelea of the disease.

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Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection

Cited by 24 publications

References 19 publications

Retinal microvascular and perfusional disruption in paediatric COVID-19: A case-control optical coherence tomography angiography study

Retinal microvascular and perfusional disruption in paediatric COVID-19: A case-control optical coherence tomography angiography study

Optic Nerve Head Vessel Density Assessment in Recovered COVID-19 Patients: A Prospective Study Using Optical Coherence Tomography Angiography

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

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