Retrospective Analysis of Retinal Imaging in COVID-19 Positive Patients at a Tertiary Eye Care Center

Abstract

Purpose Since the start of the COVID-19 pandemic, numerous authors have published data demonstrating retinal changes found in patients with COVID-19. However, others have debated the significance of these findings and the effects of COVID-19 on the retina remain uncertain. This study aims to better understand retinal findings in patients with COVID-19. Patients and Methods A retrospective review of patients with a history of a positive COVID-19 polymerase chain reaction test was performed between March 1st, 2020 and October 31st, 2020. Patients were included if they presented within 90 days of their first positive COVID-19 test and underwent color fundus photography and/or OCT of the macula. All images were reviewed by two independent graders who assessed the presence of retinal heme, cotton wool spots, vascular sheathing, and disc edema, as well as hyper-reflective changes, intra-retinal fluid, and sub-retinal fluid on OCT. Results A total of 119 eyes from 61 patients were included. Among 83 eyes which underwent OCT of the macula, inner retinal hyper-reflective changes were seen in 16.9% (n=14), outer retinal hyper-reflective changes in 18.1% (n=15), intra-retinal fluid in 28.9% (n=24), and sub-retinal fluid in 14.5% (n=12). Among 48 eyes which underwent color fundus photography, retinal hemorrhage was seen in 27.1% (n=13), optic disc edema in 2.1% (n=1), and cotton wool spots in none of the eyes. Sub-analysis of 70 eyes from 41 patients with no alternative retinal pathology to potentially explain the above findings revealed none of the above exam findings on OCT of the macula (n=35), fundus photography (n=28), or documented exam (n=66). Conclusion While a number of patients seen after COVID-19 infection demonstrated retinal findings, all could be explained by pre-existing retinal conditions. In a sub-group of eyes without pre-existing retinal disease, we did not identify any retinal findings that could be associated with COVID-19.

Tomographic Findings in the Retina of Unvaccinated Patients with COVID Pneumonia: Prospective Longitudinal Study

“…Invernizzi et al [25] described a greater frequency of hemorrhages, cotton-wool exudates, and vascular tortuosity in patients with COVID-19 compared to controls. Similarly, Patel et al [26] reported in a retrospective study that hemorrhages and cotton-wool exudates were present in the retina of up to 30% of patients with COVID-19. The low prevalence of diabetes mellitus, hypertension, and smoking in our series of patients may be related to the absence of pathological findings, since these comorbidities are confounders independently associated with the appearance of ischemic, hemorrhagic, and inflammatory lesions in the retina.…”

Retinal tissue and microvasculature loss in COVID-19 infection

“…Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus two (SARS-CoV-2). In December 2019, an outbreak of this respiratory disease emerged in Wuhan, China which was declared a pandemic in March 2020 and has affected many lives since then 1 . As of October 17, 2022, the total number of confirmed cases globally per the World Health Organization (WHO) is 621,797,133, with total deaths of 6,545,561 2 .…”