Abstract
Purpose :
Since the start of the COVID-19 pandemic, numerous authors have published data demonstrating retinal changes found in patients with COVID-19. These include differences in retinal vascular anatomy, hyper-reflective changes on optical coherence tomography (OCT), and signs of microvascular disease such as cotton wool spots and retinal hemorrhages. However, other authors have debated the validity of these findings and the effects of COVID-19 on the retina remain uncertain. Herein, we aim to retrospectively assess for retinal changes in patients infected by COIVD-19 who were seen at a tertiary eye care center.
Methods :
A retrospective review of patients who presented to Massachusetts Eye and Ear (Boston, MA, USA) between March 1st and October 31st, 2020 with a history of a positive COVID-19 polymerase chain reaction test was performed. 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.
Results :
A total of 119 eyes from 61 patients with mean age of 63 years and mean presentation of 60.4 days after first positive COVID-19 test (range 4 to 90 days) 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. Among 109 eyes which underwent a documented exam of the posterior segment, retinal hemorrhage was seen in 23.9% (n=26), optic disc edema in 2.75% (n=3), and cotton wool spots in 3.7% (n=4). Sub-analysis of 70 eyes from 41 patients with no alternative retinal pathology (diabetic retinopathy, retinal vein occlusion, etc.) to potentially cause the above findings revealed that none of the eyes demonstrated any of the above exam findings on OCT macula (n=35), fundus photography (n=28), or documented exam (n=66).
Conclusions :
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 attributed to COVID-19.
This is a 2021 ARVO Annual Meeting abstract.