Retinal findings in patients with COVID-19: Results from the SERPICO-19 study

Abstract

Background Coronavirus disease 2019 (COVID-19) has been associated to microvascular alterations. We screened the fundus of patients with COVID-19 to detect alterations of the retina and its vasculature and to assess possible correlations with clinical parameters. Methods Cross-sectional study. The presence of retinal alterations in patients with COVID-19 and subjects unexposed to the virus was assessed using fundus photographs and their prevalence was compared. Mean arteries diameter (MAD) and mean veins diameter (MVD) were compared between patients and unexposed subjects with multiple linear regression including age, sex, ethnicity, body mass index, smoking/alcohol consumption, hypertension, hyperlipidaemia, diabetes as covariates. The influence of clinical/lab parameters on retinal findings was tested in COVID-19 patients. Findings 54 patients and 133 unexposed subjects were enrolled. Retinal findings in COVID-19 included: haemorrhages (9·25%), cotton wools spots (7·4%), dilated veins (27·7%), tortuous vessels (12·9%). Both MAD and MVD were higher in COVID-19 patients compared to unexposed subjects (98·3 ± 15·3 µm vs 91·9 ± 11·7 µm, p = 0.006 and 138·5 ± 21·5 µm vs 123·2 ± 13·0 µm, p <0.0001, respectively). In multiple regression accounting for covariates MVD was positively associated with COVID-19 both in severe (coefficient 30·3, CI95% 18·1–42·4) and non-severe (coefficient 10·3, CI95% 1·6–19·0) cases compared to unexposed subjects. In COVID-19 patients MVD was negatively correlated with the time from symptoms onset (coefficient −1·0, CI 95% −1·89 to −0·20) and positively correlated with disease severity (coefficient 22·0, CI 95% 5·2–38·9). Interpretation COVID-19 can affect the retina. Retinal veins diameter seems directly correlated with the disease severity. Its assessment could have possible applications in the management of COVID-19. Funding None.

Optical coherence tomography angiography findings in patients with COVID-19

“…Invernizzi et al found retinal hemorrhages, cotton wool spots, dilated veins, and an increase in vascular tortuosity in patients with COVID-19. 10 Although the authors stated that such findings indicating microangiopathy might be secondary to COVID-19 or incidental, they also speculated that the virus itself or the systemic treatments used might have triggered microangiopathy in patients with systemic vascular disease. 10 Virgo et al found paracentral acute middle maculopathy and acute macular neuroretinopathy lesions in 2 cases who recently had COVID-19 infection, which may indicate ischemic events in different retinal capillary beds.…”

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

“…In fact, about 50% of COVID-19 patients with ocular abnormalities were classified as critical, 16.7% were classified as severe, and 33.3% were classified as moderate severity ( 97 ). In addition to conjunctivitis other ocular abnormalities directly correlated with the COVID-19 severity seem to be alterations in retina and in its vasculature ( 100 ). A recent study evaluating the retina of patients with COVID-19, within 30 days from the onset of systemic symptoms, found an enlargement of retinal arteries and veins in more severe cases and showed an inverse correlation with time to symptoms onset ( 100 ).…”

“…In addition to conjunctivitis other ocular abnormalities directly correlated with the COVID-19 severity seem to be alterations in retina and in its vasculature ( 100 ). A recent study evaluating the retina of patients with COVID-19, within 30 days from the onset of systemic symptoms, found an enlargement of retinal arteries and veins in more severe cases and showed an inverse correlation with time to symptoms onset ( 100 ). In this context, Casagrande et al demonstrate the existence of SARS-CoV-2 nucleic acid in the human retina COVID-19 patients ( 101 ).…”

Resident Perspectives 56–1

“…By contrast, a recent study by Invernizzi and colleagues demonstrated that dilation in retinal arteries and veins, assessed by computer-based analysis, was significantly greater in the COVID-19 patients than in healthy controls, implying an inflammatory response or endothelial damage from COVID infection. 3 In addition, angiotensin-covering enzyme (ACE) receptors, which mediate the infectious cascade of COVID infection, have been found in the choroid, muller cells, ganglion cells, retinal vascular endothelial cells, and photoreceptors. 4 Therefore, pathoanatomical abnormalities can be expected following severe infections in older adults.…”