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Fundus evaluation in COVID-19 positives with non-severe disease
Ravi Bypareddy1, B L Sujatha Rathod1, Y D Shilpa1
1Department of Vitreo-Retina, Regional Institute of Ophthalmology, Minto Ophthalmic Hospital, BMCRI, Bengaluru, Karnataka, India.
Insights
Retinal examination in mild-to-moderate coronavirus disease-2019 (COVID-19) patients revealed no significant inflammatory or vaso-occlusive lesions. A single retinal hemorrhage was observed in one patient, likely incidental, suggesting COVID-19 does not cause major retinal changes in nonsevere cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Retinal Imaging
Background:
- Coronavirus disease-2019 (COVID-19) can affect various organ systems.
- Ocular manifestations of COVID-19 are being investigated, particularly retinal changes.
- Understanding retinal involvement in nonsevere COVID-19 is crucial for comprehensive patient care.
Purpose of the Study:
- To document and analyze retinal changes in COVID-19 positive patients with nonsevere disease.
- To utilize a nonmydriatic handheld fundus camera for retinal imaging in COVID-19 patients.
- To assess the correlation between COVID-19 infection and retinal pathologies.
Main Methods:
- A cross-sectional observational study was conducted on 138 COVID-19 patients with nonsevere symptoms.
- Excluded were ICU-admitted patients and those with pre-existing conditions like diabetes or hypertension.
- Retinal examinations included anterior segment evaluation, indirect ophthalmoscopy, and fundus imaging using a nonmydriatic handheld camera.
Main Results:
- No inflammatory, infective, or vaso-occlusive retinal lesions were found in the majority of patients.
- One patient (0.72%) presented with a single streak of superficial retinal hemorrhage in the posterior pole, away from the fovea.
- Laboratory findings showed mild anemia in 12 patients, elevated leucocyte count in 6, and raised LDH and CRP in a significant number.
Conclusions:
- Mild-to-moderate COVID-19 infection did not appear to cause significant retinal inflammatory or vaso-occlusive lesions.
- The single observed retinal hemorrhage was likely incidental and not directly attributable to COVID-19.
- Further research may be needed to fully elucidate the long-term ocular effects of COVID-19.
Purpose:
The aim of this work was to study and document retinal changes in coronavirus disease-2019 (COVID-19) positive patients with nonsevere disease using a nonmydriatic handheld fundus camera.
Methods:
A cross-sectional observational study was conducted on patients affected by COVID-19 who were admitted at our center. Our study included patients with no, mild, and moderate symptoms (nonsevere cases). Intensive care unit (ICU)-admitted patients were excluded considering the difficulty in procuring the fundus image by the handheld camera due to patients positioning. Patients with systemic conditions (diabetes, hypertension, and severe anemia) known to cause retinopathy were also excluded. Bedside anterior segment examination, fundus examination using indirect ophthalmoscopy and fundus imaging of each patient using a nonmydriatic handheld fundus camera was done by a trained ophthalmologist posted for COVID duty.
Results:
In a cohort of 138 patients, 94 (68.1%) were men and 44 (31.9%) were women. A total of 276 eyes were evaluated. The mean age of the patients was 38.51 ± 14.4 years. Anterior segment evaluation showed no abnormality in any of the eyes. On fundus screening using nonmydriatic handheld camera, a single streak of superficial retinal hemorrhage was noted at the posterior pole of the fundus in the left eye of one patient (0.72%), which was away from fovea. Laboratory tests revealed low hemoglobin (between 10 and 10.9 g/dL falling under mild Anemia) in 12 patients, elevated total leucocyte count in 6 patients, raised LDH in majority of patients (323 ± 101 Units/L) and elevated CRP (14.6 ± 30.99 mg/L). Rest of the lab parameters were within the normal range.
Conclusion:
In our study, COVID patients with mild-to-moderate symptoms did not show any inflammatory/infective or vaso-occlusive lesions in the retina attributable to COVID-19 infection, except one patient who had a single streak hemorrhage in the macula away from fovea, probably incidental.
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