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Cosmo E, Frizziero L, Schiavon S, Cattelan AM, Leoni D, Capizzi A, Torresin T, Midena G, Armato Smaniotto Dai Roveri E, Parrozzani R, Midena E. The neurovascular retinal involvement in a large population of patients recovered from COVID-19: an OCT and OCT angiography study. Eye (Lond) 2024; 38:1674-1680. [PMID: 38402287 PMCID: PMC11156865 DOI: 10.1038/s41433-024-02991-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND This study aimed to assess the neuronal and microvascular retinal and choroidal involvement in COVID-19 recovered patients using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS This observational cross-sectional study recruited patients recovered from COVID-19 and a group of healthy controls for comparisons. OCT (peripapillary scan and macular map) and OCTA (macular map) were performed to obtain: the central subfield thickness (CST), the macular volume (MV), the peripapillary retinal nerve fibre layer (pRNFL) thickness, the vessel area density (VAD), vessel length fraction (VLF), vessel diameter index (VDI) and fractal dimension (FD) of the superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP), and the vessel density (VD), stromal density (SD) and vascular/stromal (V/S) ratio of the choriocapillaris (CC) and choroid (Ch). Data regarding disease severity, administered therapy and prior comorbidities were collected. RESULTS We recruited 676 eyes from 338 patients and 98 eyes from 49 healthy controls. VAD of all the three retinal plexuses, VLF and VDI of ICP and DCP and VD of CC were significantly reduced in patients versus controls. No differences were found in CST, MV and pRNFL. A multivariate analysis showed that oxygen therapy, previous cardio/cerebrovascular events and hypertension negatively influenced vascular parameters. CONCLUSION A microvascular retinal and choriocapillaris damage may be identified secondary to SARS-CoV-2 infection, even after recovery. OCTA may represent a reproducible and non-invasive tool to assess microangiopathy in these patients, with particular regard to those with previous cardio/cerebrovascular events, hypertension and those who received oxygen therapy.
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Affiliation(s)
- Eleonora Cosmo
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Luisa Frizziero
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Stefano Schiavon
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Anna Maria Cattelan
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128, Padova, Italy
| | - Davide Leoni
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128, Padova, Italy
| | - Alfio Capizzi
- Department of Directional Hospital Management, University of Padova, 35128, Padova, Italy
| | - Tommaso Torresin
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | | | | | - Raffaele Parrozzani
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Edoardo Midena
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy.
- IRCCS-Fondazione Bietti, 00198, Rome, Italy.
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Zhang C, Cheng S, Chen H, Yang J, Chen Y. New findings on retinal microvascular changes in patients with primary COVID-19 infection: a longitudinal study. Front Immunol 2024; 15:1404785. [PMID: 38835770 PMCID: PMC11148381 DOI: 10.3389/fimmu.2024.1404785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose To investigate the longitudinal alterations of retinal microvasculature in patients with primary coronavirus disease 2019 (COVID-19) infection. Methods A cohort of participants, who had never been infected with COVID-19, was recruited between December 2022 and May 2023 at Peking Union Medical College Hospital in Beijing, China. Participants underwent comprehensive ophthalmologic examinations and fundus imaging, which included color fundus photography, autofluorescence photography, swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography (SS-OCTA). If participants were infected with COVID-19 during the study, follow-ups with consistent imaging modality were conducted within one week and two months after recovery from the infection. Results 31 patients (61 eyes), with a mean age of 31.0 ± 7.2 years old, were eligible for this study. All participants contracted mild COVID-19 infection within one month of baseline data collection. The average period was 10.9 ± 2.0 days post-infection for the first follow-up and 61.0 ± 3.5 days for the second follow-up. No clinical retinal microvasculopathy features were observed during the follow-ups. However, SS-OCTA analysis showed a significant increase in macular vessel density (MVD) from 60.76 ± 2.88% at baseline to 61.59 ± 3.72%(p=0.015) at the first follow-up, which subsequently returned to the baseline level of 60.23 ± 3.33% (p=0.162) at the two-month follow-up. The foveal avascular zone (FAZ) remained stable during the follow-ups with areas of 0.339 ± 0.097mm2, 0.342 ± 0.093mm2, and 0.344 ± 0.098mm2 at the baseline, first follow-up (p=0.09) and second follow-up (p=0.052), respectively. Central macular thickness, cube volume and ganglion cell-inner plexiform layer showed a transient decrease at the first follow-up(p<0.001, p=0.039, p=0.002, respectively), and increased to baseline level at the two-month follow-up(p=0.401, p=0.368, p=0.438, respectively). Conclusion Mild COVID-19 infection may temporarily and reversibly impact retinal microvasculature, characterized by a transient increase in retinal blood flow during the early recovery phase, which returns to the pre-infection level two months post-infection.
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Affiliation(s)
- Chenxi Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shiyu Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Pai V, Bileck A, Hommer N, Janku P, Lindner T, Kauer V, Rumpf B, Haslacher H, Hagn G, Meier-Menches SM, Schmetterer L, Schmidl D, Gerner C, Garhöfer G. Impaired retinal oxygen metabolism and perfusion are accompanied by plasma protein and lipid alterations in recovered COVID-19 patients. Sci Rep 2024; 14:8395. [PMID: 38600099 PMCID: PMC11006918 DOI: 10.1038/s41598-024-56834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
The aim of the present study was to investigate retinal microcirculatory and functional metabolic changes in patients after they had recovered from a moderate to severe acute COVID-19 infection. Retinal perfusion was quantified using laser speckle flowgraphy. Oxygen saturation and retinal calibers were assessed with a dynamic vessel analyzer. Arterio-venous ratio (AVR) was calculated based on retinal vessel diameter data. Blood plasma samples underwent mass spectrometry-based multi-omics profiling, including proteomics, metabolomics and eicosadomics. A total of 40 subjects were included in the present study, of which 29 had recovered from moderate to severe COVID-19 within 2 to 23 weeks before inclusion and 11 had never had COVID-19, as confirmed by antibody testing. Perfusion in retinal vessels was significantly lower in patients (60.6 ± 16.0 a.u.) than in control subjects (76.2 ± 12.1 a.u., p = 0.006). Arterio-venous (AV) difference in oxygen saturation and AVR was significantly lower in patients compared to healthy controls (p = 0.021 for AVR and p = 0.023 for AV difference in oxygen saturation). Molecular profiles demonstrated down-regulation of cell adhesion molecules, NOTCH3 and fatty acids, and suggested a bisphasic dysregulation of nitric oxide synthesis after COVID-19 infection. The results of this study imply that retinal perfusion and oxygen metabolism is still significantly altered in patients well beyond the acute phase of COVID-19. This is also reflected in the molecular profiling analysis of blood plasma, indicating a down-regulation of nitric oxide-related endothelial and immunological cell functions.Trial Registration: ClinicalTrials.gov ( https://clinicaltrials.gov ) NCT05650905.
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Affiliation(s)
- Viktoria Pai
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria
| | - Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Patrick Janku
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Theresa Lindner
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Victoria Kauer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Medicine IV for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Benedikt Rumpf
- Department of Medicine IV for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hagn
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
| | - Samuel M Meier-Menches
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria.
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria.
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Zaheer N, Tallouzi MO, Kumar NA, Sreekantam S. Outer Retinopathies Associated with COVID-19 Infection: Case Reports and Review of Literature. Case Rep Ophthalmol Med 2024; 2024:7227086. [PMID: 38495090 PMCID: PMC10942824 DOI: 10.1155/2024/7227086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 03/19/2024] Open
Abstract
Background The coronavirus disease (COVID-19) is a highly contagious disease with profound health implications. It can affect any part of the body with variable severity. Various ophthalmic manifestations of coronavirus disease have been documented. Case Presentations. We reported three cases of outer retinopathies associated with COVID-19 infection. All three patients were young females. The first two patients presented within days of COVID-19 infection with complaints of black spots in the eyes. Multimodal retinal imaging showed lesions consistent with acute macular neuroretinopathy. Lesions were bilateral in the first patient and unilateral in the second one. Our third patient presented with blurred vision in one eye, 3 months after a suspected COVID-19 infection. Retinal imaging showed outer retinopathy. Our patients' vision was good and maintained during the follow-up. All three were monitored on observation only, and symptoms and lesions improved with time. Conclusion In conclusion, COVID-19-related thromboinflammatory response can result in localized vascular inflammation and hypoperfusion in any of the retinal capillary plexuses or choriocapillaris resulting in ischemia of the corresponding retinal or choroidal layers.
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Affiliation(s)
- Naima Zaheer
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
| | - Mohammad O. Tallouzi
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N. Ajith Kumar
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
| | - Sreekanth Sreekantam
- Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham, UK
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Gokmen O, Ozgur G. Effects of COVID-19 infection on retinal vascular density and choroidal thickness measured by optical coherence tomography angiography. Photodiagnosis Photodyn Ther 2023; 44:103859. [PMID: 37871811 DOI: 10.1016/j.pdpdt.2023.103859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
AIM The present study evaluates the possible effects of COVID-19 on choroid thickness, the Foveal Avascular Zone (FAZ) and retinal vascular indices in the same individuals who had Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) data prior to the COVID-19 pandemic. METHODS The OCT and OCTA images of the same individuals with no known ophthalmic pathology who developed a COVID-19 infection were obtained were retrieved retrospectively from the database and compared with the repeated images of OCT and OCTA images 1-2 months after COVID-19 infection. RESULTS Eighty eyes of 40 patients (26 female [65%], 14 male [35%]) who had developed a prior Covid-19 infection were included in the study. When comparing the measurements of the same participants before and after Covid-19 infection, no significant difference was detected in the mean average choroidal thicknesses (p=0.998), average superficial (p=0.425) and deep (p=0.333) retinal vascular densities, and superficial (p=0.991) and deep (p=0.075) FAZ measurements. CONCLUSIONS No significant effect of COVID-19 on choroid thickness, FAZ or retinal vascular densities was noted in the present study, although there are some studies in literature with equivocal results.
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Affiliation(s)
- Onur Gokmen
- Department of Ophthalmology Van, Yuzuncu Yil University Dursun Odabasi Tip Merkezi - Van, Bardakcı Mah. Kampus, Turkey.
| | - Gokhan Ozgur
- Department of Ophthalmology Samsun, Health Sciences University Samsun Training and Research Hospital, Turkey
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6
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Noor M, McGrath O, Drira I, Aslam T. Retinal Microvasculature Image Analysis Using Optical Coherence Tomography Angiography in Patients with Post-COVID-19 Syndrome. J Imaging 2023; 9:234. [PMID: 37998081 PMCID: PMC10672226 DOI: 10.3390/jimaging9110234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023] Open
Abstract
Several optical coherence tomography angiography (OCT-A) studies have demonstrated retinal microvascular changes in patients post-SARS-CoV-2 infection, reflecting retinal-systemic microvasculature homology. Post-COVID-19 syndrome (PCS) entails persistent symptoms following SARS-CoV-2 infection. In this study, we investigated the retinal microvasculature in PCS patients using OCT-angiography and analysed the macular retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness via spectral domain-OCT (SD-OCT). Conducted at the Manchester Royal Eye Hospital, UK, this cross-sectional study compared 40 PCS participants with 40 healthy controls, who underwent ophthalmic assessments, SD-OCT, and OCT-A imaging. OCT-A images from the superficial capillary plexus (SCP) were analysed using an in-house specialised software, OCT-A vascular image analysis (OCTAVIA), measuring the mean large vessel and capillary intensity, vessel density, ischaemia areas, and foveal avascular zone (FAZ) area and circularity. RNFL and GCL thickness was measured using the OCT machine's software. Retinal evaluations occurred at an average of 15.2 ± 6.9 months post SARS-CoV-2 infection in PCS participants. Our findings revealed no significant differences between the PCS and control groups in the OCT-A parameters or RNFL and GCL thicknesses, indicating that no long-term damage ensued in the vascular bed or retinal layers within our cohort, providing a degree of reassurance for PCS patients.
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Affiliation(s)
- Maha Noor
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Orlaith McGrath
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Ines Drira
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
- Ophtalmologie Département, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France
| | - Tariq Aslam
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
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7
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Peschke P, Weinand F. [Bilateral retinal hemorrhage after acute respiratory distress syndrome (ARDS) with COVID-19 pneumonia]. DIE OPHTHALMOLOGIE 2023; 120:652-655. [PMID: 35925349 PMCID: PMC9253253 DOI: 10.1007/s00347-022-01676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022]
Affiliation(s)
- P Peschke
- Klinik für Augenheilkunde, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
| | - F Weinand
- Klinik für Augenheilkunde, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
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Bajka A, Muth DR, Wiest MRJ, Said S, Rejdak M, Sidhu S, Foa N, Blaser F, Barthelmes D, Toro MD, Souied EH, Deuel JW, Schlagenhauf P, Zweifel SA. Analysis of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) Parameters in Young Adults after SARS-CoV-2 Infection (COVID-19) Compared with Healthy Young Controls. Diagnostics (Basel) 2023; 13:diagnostics13071283. [PMID: 37046498 PMCID: PMC10093659 DOI: 10.3390/diagnostics13071283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose: To compare retinal changes in young adults with previous SARS-CoV-2 infection with healthy young controls using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods: This prospective single-center study was conducted at the University Hospital of Zurich, Zurich, Switzerland. Participants were imaged from May to November 2021 using the SOLIX device (Visionix International SAS, Pont-de-l’Arche, France). We performed 12 mm × 12 mm, 6.4 mm × 6.4 mm, 6 mm × 6 mm and 3 mm × 3 mm OCT and OCTA scans, as well as fundus photography of each participant’s eyes. Results: In total, 466 participants were imaged. Of these, 233 were healthy controls with negative RT-PCR tests for SARS-CoV-2, 168 were young adults who had a SARS-CoV-2 infection at least 180 days previously, 19 were participants who had a SARS-CoV-2 infection < 180 days previously, and 46 were participants with asymptomatic SARS-CoV-2 infection (i.e., serologically positive but with no symptoms). Compared with healthy controls, statistically significant differences were found for OCTA recordings of the optic disc for the whole image (WI) and WI capillary vessel density, with both being higher in the SARS-CoV-2 group. Conclusion: Statistically significant results were only observed for selected variables, and in parts, only unilaterally, with relatively large p values (p = 0.02–0.03). Thus, we did not interpret these as clinically significant, leading to the conclusion that young and otherwise healthy individuals (mainly men) seem to recover from mild COVID-19 infections with no ophthalmological residues.
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Affiliation(s)
- Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | | | - Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Magdalena Rejdak
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sophia Sidhu
- Faculty of Medicine, University of California, San Diego, CA 92093, USA
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, 80138 Naples, Italy
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil, University Paris Est Creteil, 94000 Creteil, France
| | - Jeremy Werner Deuel
- Department of Global and Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
- Division of Medical Oncology and Haematology, University Hospital of Zurich, 8006 Zurich, Switzerland
| | - Patricia Schlagenhauf
- Department of Global and Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
- MilMedBiol—Centre of Competence for Military Medicine Biology, University of Zurich, 8006 Zurich, Switzerland
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-255-87-94
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Jevnikar K, Meglič A, Lapajne L, Logar M, Vidovič Valentinčič N, Globočnik Petrovič M, Jaki Mekjavić P. The Comparison of Retinal Microvascular Findings in Acute COVID-19 and 1-Year after Hospital Discharge Assessed with Multimodal Imaging-A Prospective Longitudinal Cohort Study. Int J Mol Sci 2023; 24:ijms24044032. [PMID: 36835445 PMCID: PMC9966689 DOI: 10.3390/ijms24044032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
This study aimed to quantify possible long-term impairment of the retinal microcirculation and microvasculature by reassessing a cohort of patients with acute COVID-19 without other known comorbidities one year after their discharge from the hospital. Thirty patients in the acute phase of COVID-19 without known systemic comorbidities were enrolled in this prospective longitudinal cohort study. Fundus photography, SS-OCT, and SS-OCTA using swept-source OCT (SS-OCT, Topcon DRI OCT Triton; Topcon Corp., Tokyo, Japan) were performed in the COVID-19 unit and 1-year after hospital discharge. The cohort's median age was 60 years (range 28-65) and 18 (60%) were male. Mean vein diameter (MVD) significantly decreased over time, from 134.8 μm in the acute phase to 112.4 μm at a 1-year follow-up (p < 0.001). A significantly reduced retinal nerve fiber layer (RNFL) thickness was observed at follow-up in the inferior quadrant of the inner ring (mean diff. 0.80 95% CI 0.01-1.60, p = 0.047) and inferior (mean diff. 1.56 95% CI 0.50-2.61, p < 0.001), nasal (mean diff. 2.21 95% CI 1.16-3.27, p < 0.001), and superior (mean diff. 1.69 95% CI 0.63-2.74, p < 0.001) quadrants of the outer ring. There were no statistically significant differences between the groups regarding vessel density of the superior and deep capillary plexuses. The transient dilatation of the retinal vessels in the acute phase of COVID-19, as well as RNFL thickness changes, could become a biomarker of angiopathy in patients with severe COVID-19.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andrej Meglič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Luka Lapajne
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Mateja Logar
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nataša Vidovič Valentinčič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Globočnik Petrovič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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Jevnikar K, Meglič A, Lapajne L, Logar M, Vidovič Valentinčič N, Globočnik Petrovič M, Jaki Mekjavić P. The impact of acute COVID-19 on the retinal microvasculature assessed with multimodal imaging. Graefes Arch Clin Exp Ophthalmol 2022; 261:1115-1125. [PMID: 36334115 PMCID: PMC9638292 DOI: 10.1007/s00417-022-05887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To quantify retinal microvascular findings in the acute phase of COVID-19 using multimodal imaging and compare them with healthy, age-matched controls. METHODS Hospitalized patients in the acute phase of COVID-19 without known systemic comorbidities (n = 75) and healthy controls (n = 101) aged 18-65 were enrolled in this prospective cross-sectional study. The retinal microcirculation and microvasculature impairments were assessed using fundus photography, swept-source optical coherence tomography, and swept-source optical coherence tomography angiography in the COVID-19 unit and compared with healthy, age-matched controls. RESULTS Retinal findings were predominately observed in patients with severe disease (P = 0.006). Patients with severe disease were shown to have increased both mean vein diameter (Coef. = 19.28, 95% CI: 7.34-31.23, P = 0.002) and mean artery diameter (Coef. = 11.07, 95% CI: 0.84-21.67, P = 0.044). Neither blood vessel diameters were correlated with any confounding variables (age, sex, treatment with oxygen, LDH, or ferritin). Patients with severe COVID-19 were shown to have significantly increased retinal nerve fiber layer thickness in the superior and inferior quadrants both in the inner (S: P = 0.046; I: P = 0.016) and outer (S: P = 0.026; I: P = 0.014) ring and significantly increased GCL thickness in the outer temporal quadrant (P = 0.038). There were no statistically significant differences in vessel density or the foveal avascular zone area between the groups. CONCLUSION The severity of COVID-19 was significantly correlated with the presence of retinal microangiopathy, which could become a biomarker of angiopathy in patients with COVID-19.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Meglič
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Luka Lapajne
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Mateja Logar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Vidovič Valentinčič
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Globočnik Petrovič
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. .,Jozef Stefan Institute, Ljubljana, Slovenia.
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11
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Yılmaz Çebi A, Kılıçarslan O, Uçar D. Evaluation of Retinal Microvascular Impairment after COVID-19 and its Clinical Correlates Using Optical Coherence Tomography Angiography. Turk J Ophthalmol 2022; 52:324-330. [PMID: 36317806 PMCID: PMC9631506 DOI: 10.4274/tjo.galenos.2022.87036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives Retinal vascular complications have been described in patients with coronavirus disease 2019 (COVID-19). This study aimed to analyze retinal microvascular changes and their correlations with clinical findings. Materials and Methods This case-controlled study was conducted in a university hospital. The right eyes of 52 otherwise healthy patients recovered from COVID-19 and 42 healthy controls were examined with optical coherence tomography angiography. Mann-Whitney U test was used to compare vessel density (VD) and foveal avascular zone (FAZ) parameters. Associations with treatment choices, pneumonia, and laboratory findings were analyzed. Results Twenty-nine patients (56%) and 18 healthy controls (43%) were men. Mean age of the COVID-19 group was 39.00±13.04 years. Twenty-two patients had pneumonia, 18 (35%) received hydroxychloroquine (HCQ), 17 (33%) received HCQ plus low-molecular-weight heparin (LMWH), and 10 (19%) received favipiravir. The patient group had lower parafoveal VD in the superficial capillary plexus (SCP) and lower parafoveal VD and perifoveal VD in the deep capillary plexus (DCP) than controls (p=0.003, p=0.004, p=0.001). FAZ area did not differ significantly (p=0.953). Perifoveal VD in the DCP was also significantly lower in the HCQ+LMWH group than the HCQ group (p=0.020) and in the presence of pneumonia (p=0.040). C-reactive protein (CRP) and ferritin levels were negatively correlated with perifoveal VD in the DCP (r=-0.445, p=0.023; r=-0.451, p=0.040). Ferritin was also negatively correlated with parafoveal VD in the SCP (r=-0.532, p=0.013). Conclusion Parafoveal and perifoveal VD was found to be lower in the COVID-19 group. Presence of pneumonia, need for LMWH prophylaxis, and levels of CRP and ferritin were found to be negatively associated with retinal VD. Large-scale studies are needed to evaluate the clinical importance.
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Affiliation(s)
| | | | - Didar Uçar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey,* Address for Correspondence: İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey E-mail:
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12
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Chiosi F, Campagna G, Rinaldi M, Manzi G, dell'Omo R, Fiorentino G, Toro M, Tranfa F, D'Andrea L, Rejdak M, Costagliola C. Optical Coherence Tomography Angiography Analysis of Vessel Density Indices in Early Post-COVID-19 Patients. Front Med (Lausanne) 2022; 9:927121. [PMID: 35836940 PMCID: PMC9273855 DOI: 10.3389/fmed.2022.927121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose A hypercoagulable state has been reported to cause potential sight-threatening ischemia in patients suffering from Coronavirus disease 2019 (COVID-19). This study aimed to determine whether vessel density (VD), as measured by optical coherence tomography angiography (OCT-A), has insights into retinal and choriocapillaris vascular changes in patients affected by SARS-CoV-2 infection. Methods Hundred and fifty two patients positive for SARS-CoV-2 infection were enrolled in this observational, retrospective, controlled study. A control group of 60 healthy subjects was selected for statistical comparisons. Raw OCT and OCT-A data were exported and 3D datasets were analyzed to determine VD. Results Hundred and forty eyes (92.1%) were included for final analysis. The VD of the superficial capillary plexus (SCP) did not differ between the two groups. The mean VD of the deep capillary plexus (DCP) and the choriocapillaris (CC) was significantly lower in the foveal sector of the COVID-19 group compared to healthy controls. Within the post-COVID-19 group, the lowest DCP and CC foveal VD values were recorded in patients treated with antiviral therapy; no differences were observed among COVID-19 patients with other comorbidities (hypertension, diabetes, thyroid disease) or taking antiplatelet therapy. DCP and CC foveal VD were significantly lower in patients hospitalized in an intensive care unit (ICU) than asymptomatic patients. Conclusion Foveal vessel density at the level of DCP and CC was reduced in post-COVID-19 patients. Further studies evaluating these changes over time will be needed to corroborate the hypothesis of a microvascular retinal impairment in individuals who have recently recovered from SARS-CoV-2 infection.
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Affiliation(s)
- Flavia Chiosi
- Department of Ophthalmology, Azienda Ospedaliera dei Colli–Ospedale Monaldi, Naples, Italy
| | - Giuseppe Campagna
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome “Sapienza”, Rome, Italy
| | - Michele Rinaldi
- Department of Ophthalmology, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Gianluigi Manzi
- Department of Ophthalmology, Azienda Ospedaliera dei Colli–Ospedale Monaldi, Naples, Italy
| | - Roberto dell'Omo
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Giuseppe Fiorentino
- Respiratory semi-intensive Care Unit (UTSIR) COVID, Azienda Ospedaliera dei Colli–D. Cotugno, Naples, Italy
| | - Mario Toro
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
| | - Fausto Tranfa
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
| | - Luca D'Andrea
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
| | - Magdalena Rejdak
- Department of Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Ciro Costagliola
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
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Abrishami M, Daneshvar R, Emamverdian Z, Saeedian N, Tohidinezhad F, Eslami S, Ansari-Astaneh MR. Spectral-domain optical coherence tomography assessment of retinal and choroidal changes in patients with coronavirus disease 2019: a case-control study. J Ophthalmic Inflamm Infect 2022; 12:18. [PMID: 35716213 PMCID: PMC9206085 DOI: 10.1186/s12348-022-00297-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives This study aimed to evaluate the retinal and choroidal changes in the macular region of patients with Coronavirus Disease 2019 (COVID-19) using structural spectral-domain optical coherence tomography (SD-OCT) analysis. Methods This cross-sectional observational case-control study included patients recovered from COVID-19. The COVID-19 in all participants was confirmed using the reverse transcription-polymerase chain reaction (RT-PCR) technique. The participants had mild to moderate degree of disease without a history of hospitalization, steroid usage, or blood saturation below 92%. Macular SD-OCT was performed at least two weeks and up to one month after recovery from systemic COVID-19. Quantitative and qualitative changes detected by macular SD-OCT imaging were evaluated in COVID-19 recovered patients and compared with the results of age-matched normal controls. Results Participants in this study included 30 cases (60 eyes) and 60 healthy controls (120 eyes). In total, 17 (28.3%) eyes in patient group showed at least one abnormal finding indicated by macular SD-OCT imaging included hyperreflective lesions in different retinal layers. In addition, dilated choroidal vessels and retinal pigment epitheliopathy were evident in 41 (68.3.6%) and 4 (6.6%) eyes in patient group, respectively, and their OCT findings resembled those with pachychoroid spectrum. No statistically significant differences were observed in retinal layers or retinal volume between the two groups. The mean ± SD subfoveal choroidal thickness (SFCT) was determined at 380.3 ± 12.40 μm, which was significantly thicker than that in control group (310.7 ± 57.5 μm) (P < 0.001). Conclusion Regarding retinal thickness, no significant change was observed in different retina layers of patients with COVID-19; however, there were striking qualitative changes, such as hyperreflective lesions in different retinal layers. The evaluation of choroidal structure and thickness demonstrated remarkable abnormal pachyvessels and significant thickening of the SFCT but the clinical significance of these findings is unknown.
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Affiliation(s)
- Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Daneshvar
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Emamverdian
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Saeedian
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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14
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Peripapillary Nerve Fiber Layer Thickness and Optic Nerve Head Parameters in Patients Recovered from COVID-19: A Longitudinal Study. J Ophthalmol 2022; 2022:4643973. [PMID: 35368999 PMCID: PMC8968351 DOI: 10.1155/2022/4643973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/01/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To quantify the longitudinal changes of the optic nerve head (ONH) parameters and peripapillary retinal nerve fiber layer (pRNFL) thickness in patients recovered from coronavirus disease 2019 (COVID-19) using spectral-domain optical coherence tomography (OCT) analysis. Materials and Methods In an observational longitudinal study, in patients recovered from COVID-19, ONH OCT images were recorded at least two weeks after recovery from the systemic disease as the baseline and after one and three-month follow-up. Ganglion cell complex (GCC) analysis, ONH parameters, and pRNFL thickness changes were measured. Results A total of 36 eyes from 18 recovered COVID-19 patients including eleven (61.2%) females were studied. The average age was 35.5 ± 7.5 years. The pRNFL thickness in the nasal lower sector significantly decreased from 77 ± 18 μm in the first post-COVID-19 month to 74 ± 10 μm in the third month (P=0.8). The average, superior, and inferior pRNFL thickness remained unchanged. The average cup volume significantly decreased from 0.27 ± 0.15 mm3 at baseline to 0.19 ± 0.15 mm3 in the third post-COVID-19 visit (P=0.028). In terms of ONH morphologies including rim, disc and cup to disc area, and the vertical and horizontal ratio, the changes were not significant over the 3-month study period. Focal loss volume and global loss volume values were not changed significantly. Conclusion Localized defect in the nasal lower sector of pRNFL is observed in 3-month post-recovery from COVID-19. Larger studies with longer follow-ups are required to reveal the exact changes in ONH parameters.
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