COVID-19 And Eyes: Doctors Report Case Of Retinal Vein Occlusion Due To COVID-19 In Patient. More Cases Of Eyes Being Attacked By SARS-CoV-2 Emerging
: Doctors from India have reported the first documented case vasculitic retinal vein occlusion due to COVID-19.
The documented report was submitted by Dr Jay Umed Sheth and colleagues from the Surya Eye Institute and Research Centre in Mumbai.
The detailed case report has been published in the Indian Journal of Ophthalmology. https://www.ijo.in/article.asp?issn=0301-4738;year=2020;volume=68;issue=10;spage=2291;epage=2293;aulast=Sheth
The concerned patient was described as a 52-year-old male diagnosed around 10 days back by PCR as positive for COVID-19 and had presented complaints of decreased vision in the left eye for the past 1 day.
The presented clinical and ocular investigation findings in the left eye were as follows:
-Best Corrected Visual acuity was 6/60
-Fundus examination showed inferior hemiretinal vein occlusion with superonasal branch retinal vein occlusion and macular oedema
-Fundus fluorescein angiography (FFA) revealed dilated and tortuous retinal veins in inferior and superonasal quadrants. There was significant vessel wall staining and leakage in late phases suggestive of extensive phlebitis. There was no evidence of arteritis or perivascular sparing.
-Spectral-domain optical coherence tomography (SD-OCT) showed presence of serous macular detachment and significant cystoid macular edema (CME).
Subsequent systemic workup for vasculitic and non-vasculitic causes of retinal vein occlusion was carried out.
Detailed evaluation of blood pressure, complete blood count, erythrocyte sedimentation rate, serum lipid profile, sugar levels, plasma protein electrophoresis, C-reactive protein, serum homocysteine level, serum angiotensin-converting enzyme (ACE), tuberculin skin testing, QuantiFERON-TB Gold and thrombophilia-screening showed no significant abnormality.
The study team said that a presumptive diagnosis of vasculitic retinal vein occlusion secondary to COVID-19 was made due to PCR positivity to the same and absence of any other associated cause.
Systemic vasculitis due to COVID-19 secondary to Type 3 hypersensitivity reaction and triggering of cytokine storm by the deposition of immune complexes has been extensively reported.
The study team said that the retinal vasculitis in this patient could be a part of this spectrum of systemic immune mediated vasculitis.
It was noted that similar occlusive retinal vasculitis has been reported with other viral infections like dengue and chikungunya
Following this presumptive diagnosis, the patient was treated with oral methylprednisolone and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection.
Recent studies recommend treatment with steroids and anti-coagulants like heparin to prevent thromboembolic complications associated with systemic vasculitis in COVID-19. Oral steroids were started in accordance to the same. At the end of a month, the best corrected visual acuity in the left eye improved to 6/9 with com
plete resolution of the serous detachment and edema at the macula.
Such ocular manifestations in COVID-19 are uncommon with conjunctivitis being reported as the most common presentation. A few reports of intraretinal haemorrhages and cotton wool spots are also present in literature.
The study team commented "Knowledge of this new entity will help us remain vigilant about similar vision-threatening complications while dealing with patients of COVID-19."
Doctors in India, Italy and Brazil are reporting more cases of COVID-19 patients experiencing eye problems recently.
Thailand Medical News recently covered a report on ocular inflammation becoming a common occurrence in recovered COVID-19 patients according to researchers from University Of California-San Diego. https://www.thailandmedical.news/news/news-covid-19-study-warns-that-ocular-inflammation-present-in-many-recovered-non-hospitalized-covid-19-patients
Italian researchers had also reported that the SARS-CoV-2 has an affinity for attacking the retina areas of the eyes. https://www.thailandmedical.news/news/covid-19-news-italian-researchers-find-that-sars-cov-2-can-affect-the-retina-in-the-eyes
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