COVID-19-related retinal microvasculopathy and systemic implications in patients with severe disease: results from
Niccolò Castellino1, Antonio Longo1, Andrea Russo1
1Department of Ophthalmology, University of Catania, Catania, Italy.
Insights
Retinal microvascular changes after severe COVID-19 were not reversible after 12 months. These persistent alterations in COVID-19 survivors are linked to inflammation, renal dysfunction, and aortic stiffness.
Area of Science:
- Ophthalmology
- Cardiology
- Infectious Diseases
Background:
- Severe COVID-19 can cause long-term microvascular changes.
- The reversibility and systemic links of these retinal changes remain unclear.
Purpose of the Study:
- To assess the long-term reversibility of retinal microvascular alterations post-COVID-19.
- To investigate associations between retinal changes and other vascular diseases in COVID-19 survivors.
Main Methods:
- Prospective observational study involving COVID-19 patients and controls.
- Optical coherence tomography angiography (OCTA) for retinal vascular function.
- Aortic pulse wave velocity for aortic stiffness, assessed at 1 and 12 months post-discharge.
Main Results:
- COVID-19 patients showed reduced superficial capillary plexus (SCP) vessel density and enlarged foveal avascular zone at 1 month, with no improvement at 12 months.
- Higher inflammation and lower renal function during hospitalization correlated with aortic stiffness and reduced SCP density at 1 month.
- Slower aortic dysfunction recovery was linked to poorer retinal vascular outcomes at 12 months.
Conclusions:
- Retinal microvascular alterations persist 12 months after severe COVID-19.
- These persistent changes are associated with in-hospital inflammation, renal dysfunction, and ongoing aortic stiffness.
Objectives:
To assess the reversibility of retinal microvascular changes in the long term and to investigate the potential links with other vascular diseases of COVID-19.
Methods:
We designed a prospective multicenter observational study. Patients were enrolled from the Methuselah study cohort. Retinal vascular function was studied in these patients using optical coherence tomography angiography (OCTA); aortic stiffness was measured using aortic pulse wave velocity. These examinations were performed 1 (Visit 1) and 12 (Visit 2) months after the hospital discharge for severe COVID-19. A control subject group matched for age and sex was included to define normal values.
Results:
A total of 28 control subjects (56 eyes) and 25 patients (50 eyes) completed the scheduled OCTA assessment; 18 patients (36 eyes) also completed the macrovascular examination. Compared to controls, the vessel density of the superficial capillary plexus (SCP) was reduced, whereas the foveal avascular zone area was enlarged at Visit 1 (p = 0.016 and < 0.001, respectively) and was not modified after the 12-month follow-up in COVID-19 patients (p = 0.011 and 0.001, respectively). Higher inflammation and lower renal function during hospitalization were linked to higher aortic stiffness and reduced vessel density of the SCP 1 month after the acute phase of COVID-19. A slower recovery of aortic dysfunction was linked to worse retinal vascular outcomes at Visit 2.
Conclusion:
Retinal vascular alterations were not reversible 12 months after COVID-19 and were linked to inflammation and renal dysfunction during hospitalization as well as to aortic stiffness measured during follow-up.
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