Seeking clarity on retinal findings in patients with COVID-19

Brandão-de-Resende, Camilo; Diniz-Filho, Alberto; Vasconcelos-Santos, Daniel Vítor

doi:10.1016/s0140-6736(20)31918-8

Cited by 8 publications

(6 citation statements)

References 4 publications

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“…8 However a number of other authors have questioned these findings, raising the possibility that these hyper-reflective changes can be attributed to normal retinal structures, namely retinal blood vessels. 9,[12][13][14][15][16] While similar appearing hyper-reflective structures were seen in this review of OCT imaging, all could be attributed to retinal blood vessels when correlated to simultaneous near infrared reflectance registration images of the retina. This finding further calls into question the retinal manifestations of COVID-19 that were proposed early in the pandemic.…”

Section: Discussionsupporting

confidence: 64%

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

Patel¹,

Moon²,

Katz³

et al. 2021

OPTH

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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.

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Section: Discussionsupporting

confidence: 64%

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

Patel¹,

Moon²,

Katz³

et al. 2021

OPTH

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“…Four patients presented subtle cotton wool spots and microhaemorrhages along the retinal arcade on fundus examination 16. However, these findings have been strongly questioned by other authors 17 18. Lani-Louzada’s19 group evaluated severe patients during their hospital stay, finding retinal changes in 12% (3 of 25) of patients, but they believe they are most likely secondary to clinical intercurrences or comorbidities and not a result of direct viral damage.…”

Section: Discussionmentioning

confidence: 98%

“… 16 However, these findings have been strongly questioned by other authors. 17 18 Lani-Louzada’s 19 group evaluated severe patients during their hospital stay, finding retinal changes in 12% (3 of 25) of patients, but they believe they are most likely secondary to clinical intercurrences or comorbidities and not a result of direct viral damage. Retinal findings in patients with COVID-19 include haemorrhages, cotton wool spots, dilated veins and tortuous vessels.…”

Section: Discussionmentioning

confidence: 99%

Retinal nerve fibre layer and ganglion cell layer changes in children who recovered from COVID-19: a cohort study

et al. 2021

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ObjectiveTo investigate the optic nerve and macular parameters of children who recovered from COVID-19 compared with healthy children using optical coherence tomography (OCT).DesignCohort study.SettingHospital Clinico San Carlos, Madrid.PatientsChildren between 6 and 18 years old who recovered from COVID-19 with laboratory-confirmed SARS-CoV-2 infection and historical controls were included.InterventionsAll patients underwent an ophthalmological examination, including macular and optic nerve OCT. Demographic data, medical history and COVID-19 symptoms were noted.Main outcome measuresPeripapillary retinal nerve fibre layer thickness, macular retinal nerve fibre layer thickness, macular ganglion cell layer thickness and retinal thickness.Results90 patients were included: 29 children who recovered from COVID-19 and 61 controls. Patients with COVID-19 presented an increase in global peripapillary retinal nerve fibre layer thickness (mean difference 7.7; 95% CI 3.4 to 12.1), temporal superior (mean difference 11.0; 95% CI 3.3 to 18.6), temporal inferior (mean difference 15.6; 95% CI 6.5 to 24.7) and nasal (mean difference 9.8; 95% CI 2.9 to 16.7) sectors. Macular retinal nerve fibre layer analysis showed decreased thickness in the nasal outer (p=0.011) and temporal inner (p=0.036) sectors in patients with COVID-19, while macular ganglion cell layer thickness increased in these sectors (p=0.001 and p=0.015, respectively). No differences in retinal thickness were noted.ConclusionsChildren with recent history of COVID-19 present significant changes in peripapillary and macular OCT analyses.

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“…Sampling inadequacies aside, the study proposed a causal association between COVID-19 and retinal disease using cross-sectional data that could not determine whether SARS-CoV-2 exposure had preceded the retinal lesions. Even more problematic was the attribution of these perceived imaging abnormalities to SARS-CoV-2, a hypothesis that came under severe scrutiny by several independent groups who suggested that the retinal hyperintensities represented normal retinal vessels given their stereotypical calibre, tube-like morphology, and dorsal shadowing 77–80. Furthermore, no attempt was made at the time of publication to report patient comorbidities that could have confounded the association between COVID-19 infection and observed microangiopathic changes.…”

Section: Does Sars-cov-2 Cause Ocular Disease?mentioning

confidence: 99%

COVID-19 and the eye: alternative facts The 2022 Bowman Club, David L. Easty lecture

Ung

Chodosh

2022

BMJ Open Ophth

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In addition to catastrophic loss of life, and dramatic and unwanted alterations to the daily lives of those left behind, the COVID-19 pandemic has fostered the publication and dissemination of an unprecedented quantity of peer-reviewed medical and scientific publications on a single subject. In particular, the ophthalmic literature is now replete with clinical and laboratory studies on putative eye involvement by SARS-CoV-2, the aetiologic agent of COVID-19. In this review, we critically appraise the published literature on COVID-19, and suggest that the quality of scientific peer review and editorial decision-making also suffered during the COVID-19 pandemic.

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Seeking clarity on retinal findings in patients with COVID-19

Cited by 8 publications

References 4 publications

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

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

Retinal nerve fibre layer and ganglion cell layer changes in children who recovered from COVID-19: a cohort study

COVID-19 and the eye: alternative facts The 2022 Bowman Club, David L. Easty lecture

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