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Retinal findings in patients with COVID-19: Results from the SERPICO-19 study
Alessandro Invernizzi1,2,3, Alessandro Torre4, Salvatore Parrulli1,2
1Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
Insights
Coronavirus disease 2019 (COVID-19) affects the retina, with higher retinal vein diameter linked to disease severity. This finding may aid in managing COVID-19 patients.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Vascular Biology
Background:
- Coronavirus disease 2019 (COVID-19) is associated with microvascular alterations.
- Retinal microvascular changes may serve as indicators of systemic disease impact.
Purpose of the Study:
- To investigate retinal alterations in COVID-19 patients.
- To assess correlations between retinal findings and clinical parameters.
Main Methods:
- Cross-sectional study comparing fundus photographs of COVID-19 patients and unexposed subjects.
- Analysis of mean arteries diameter (MAD) and mean veins diameter (MVD) using multiple linear regression.
- Evaluation of clinical and laboratory parameters influencing retinal findings in COVID-19 patients.
Main Results:
- Retinal findings in COVID-19 patients included hemorrhages, cotton wool spots, dilated veins, and tortuous vessels.
- Both MAD and MVD were significantly higher in COVID-19 patients compared to controls.
- Mean veins diameter (MVD) positively correlated with COVID-19 severity and negatively with time from symptom onset.
Conclusions:
- COVID-19 impacts the retina, particularly affecting retinal vein diameter.
- Retinal vein diameter is a potential biomarker for COVID-19 severity.
- Ophthalmic screening may offer insights into COVID-19 management.
Background:
Coronavirus disease 2019 (COVID-19) has been associated to microvascular alterations. We screened the fundus of patients with COVID-19 to detect alterations of the retina and its vasculature and to assess possible correlations with clinical parameters.
Methods:
Cross-sectional study. The presence of retinal alterations in patients with COVID-19 and subjects unexposed to the virus was assessed using fundus photographs and their prevalence was compared. Mean arteries diameter (MAD) and mean veins diameter (MVD) were compared between patients and unexposed subjects with multiple linear regression including age, sex, ethnicity, body mass index, smoking/alcohol consumption, hypertension, hyperlipidaemia, diabetes as covariates. The influence of clinical/lab parameters on retinal findings was tested in COVID-19 patients.
Findings:
54 patients and 133 unexposed subjects were enrolled. Retinal findings in COVID-19 included: haemorrhages (9·25%), cotton wools spots (7·4%), dilated veins (27·7%), tortuous vessels (12·9%). Both MAD and MVD were higher in COVID-19 patients compared to unexposed subjects (98·3 ± 15·3 µm vs 91·9 ± 11·7 µm, p = 0.006 and 138·5 ± 21·5 µm vs 123·2 ± 13·0 µm, p<0.0001, respectively). In multiple regression accounting for covariates MVD was positively associated with COVID-19 both in severe (coefficient 30·3, CI95% 18·1-42·4) and non-severe (coefficient 10·3, CI95% 1·6-19·0) cases compared to unexposed subjects. In COVID-19 patients MVD was negatively correlated with the time from symptoms onset (coefficient -1·0, CI 95% -1·89 to -0·20) and positively correlated with disease severity (coefficient 22·0, CI 95% 5·2-38·9).
Interpretation:
COVID-19 can affect the retina. Retinal veins diameter seems directly correlated with the disease severity. Its assessment could have possible applications in the management of COVID-19.
Funding:
None.
