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Pathogenesis of Vascular Retinal Manifestations in COVID-19 Patients: A Review

Elisa D'Alessandro1, Aki Kawasaki1, Chiara M Eandi1,2

  • 1Fondation Asile des Aveugles, Hôpital Ophtalmique Jules Gonin, University of Lausanne, 1004 Lausanne, Switzerland.

Biomedicines
|November 11, 2022
PubMed

Insights

Coronavirus disease 2019 (COVID-19) can cause retinal vascular events, including occlusions. Understanding these eye complications may reveal systemic clotting risks in COVID-19 patients.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) affects multiple organs, including the eyes.
  • While anterior segment ocular manifestations are common, posterior segment findings like retinal vascular events are less frequent.
  • Retinal vessels offer insight into systemic microvasculature and COVID-19's thrombo-occlusive complications.

Purpose of the Study:

  • To systematically review retinal arterial and/or venous manifestations in patients with COVID-19.
  • To understand the spectrum of retinal vascular events associated with COVID-19.
  • To explore potential pathogenetic mechanisms underlying these ocular complications.

Main Methods:

  • Systematic literature search for studies reporting retinal vascular manifestations in COVID-19 patients.
  • Inclusion of 21 studies detailing various retinal findings.
  • Analysis of reported pathogenetic mechanisms.

Main Results:

  • A wide range of retinal manifestations were observed, from mild signs (cotton wool spots, hemorrhages) to severe occlusions (retinal artery and vein occlusions).
  • Studies described findings such as cotton wool spots, focal and flame-shaped hemorrhages, and vein dilation.
  • Severe outcomes included retinal artery and vein occlusions.

Conclusions:

  • COVID-19 is associated with significant retinal vascular events.
  • The primary mechanisms implicated are a hypercoagulative state and a severe inflammatory response potentially leading to a disseminated intravascular coagulation-like syndrome.
  • Studying retinal vascular events in COVID-19 may provide insights into systemic thrombo-occlusive complications.

Keywords:
COVID-19mechanismpathophysiologyretinavasculature

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