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Evaluation of an Association between COVID-19 and Retinal Hemorrhage in Children
Aaron T Zhao1, Natalie Laub2, Jocelyn He3
1Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania.
Insights
This study found no link between COVID-19 infection and retinal hemorrhage in children. Retinal hemorrhage in children should not be attributed to COVID-19.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Retinal hemorrhage has been anecdotally linked to COVID-19 infection.
- Understanding this association is crucial for accurate diagnosis and treatment in pediatric cases.
Purpose of the Study:
- To investigate the association between COVID-19 infection and retinal hemorrhage in pediatric patients.
- To determine if COVID-19 is a potential cause of retinal hemorrhage in children.
Main Methods:
- Retrospective cohort study of 6,952 children (1 month to 18 years) at Children's Hospital of Philadelphia.
- Analysis of medical records for COVID-19 test results and retinal findings from dilated fundus examinations within 28 days of testing.
- Statistical analysis using generalized estimating equations to assess the association between COVID-19 and retinal hemorrhage.
Main Results:
- No statistically significant association was found between COVID-19 infection and retinal hemorrhage in children across all assessed time periods (7, 14, 21, and 28 days post-testing).
- Odds ratios (OR) ranged from 0.63 to 0.80, with P-values not reaching statistical significance (P > 0.37).
- Four COVID-19 positive children with retinal hemorrhage had alternative, plausible causes identified.
Conclusions:
- COVID-19 infection is not associated with retinal hemorrhage in pediatric patients.
- This study refutes the clinical or legal acceptance of COVID-19 as a cause of retinal hemorrhage in children.
- Ophthalmologists and clinicians should not consider COVID-19 as a potential etiology for retinal hemorrhage in the pediatric population.
Purpose:
To evaluate the association of retinal hemorrhage with coronavirus disease 2019 (COVID-19) in children.
Design:
Retrospective cohort study.
Participants:
Inpatients and outpatients at Children's Hospital of Philadelphia 1 month to 18 years of age who underwent a dilated fundus examination by an ophthalmologist within 1 month of a COVID-19 test between January 2020 and October 2023.
Methods:
Medical records were reviewed for the results of COVID-19 testing and retinal findings. Primary outcome was the association between COVID-19 and retinal hemorrhage assessed across 4 periods: retinal examination within 7 days, 14 days, 21 days, or 28 days of COVID-19 testing. Generalized estimating equations were used to determine statistical significance and to control for age and multiple COVID-19 tests.
Main Outcome Measures:
Association between COVID-19 and presence of retinal hemorrhage.
Results:
Among 6952 children (mean age, 6.1 years) studied, 3496, 4758, 5887, and 6952 children underwent a fundus examination within 1, 2, 3, and 4 weeks of a COVID-19 test, respectively. No associations were found between COVID-19 and the presence of retinal hemorrhage in any of the periods: 7 days (odds ratio, 0.80; 95% confidence interval [CI], 0.20-3.32; P = 0.76), 14 days (odds ratio, 0.75; 95% CI, 0.24-2.00; P = 0.63), 21 days (odds ratio, 0.79; 95% CI, 0.29-2.15; P = 0.64), or 28 days (odds ratio, 0.63; 95% CI, 0.23-1.72; P = 0.37). All 4 children with positive COVID-19 testing and retinal hemorrhage had alternative plausible causes with hemorrhage patterns consistent with those other causes.
Conclusions:
Coronavirus disease 2019 is not associated with retinal hemorrhage in children. Coronavirus disease 2019 should not be considered as a potential cause of retinal hemorrhage in children, and this unsupported theory should not be accepted clinically or in legal proceedings.
Financial Disclosure(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
