Peripapillary Retinal Vascular Involvement in Early Post-COVID-19 Patients

Abstract

The ability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2's) to cause multi-organ ischemia and coronavirus-induced posterior segment eye diseases in mammals gave concern about potential sight-threatening ischemia in post coronavirus disease 2019 patients. The radial peripapillary capillary plexus (RPCP) is a sensitive target due to the important role in the vascular supply of the peripapillary retinal nerve fiber layer (RNFL). Eighty patients one month after SARS-CoV-2 infection and 30 healthy patients were selected to undergo structural OCT (optical coherence tomography) and OCTA (optical coherence tomography angiography) exams. Primary outcome was a difference in RPCP perfusion density (RPCP-PD) and RPCP flow index (RPCP-FI). No significant difference was observed in age, sex, intraocular pressure (IOP) and prevalence of myopia. RPCP-PD was lower in post SARS-CoV-2 patients compared to controls. Within the post-COVID-19 group, patients with systemic arterial hypertension had lower RPCP-FI and age was inversely correlated to both RPCP-FI and RPCP-PD. Patients treated with lopinavir + ritonavir or antiplatelet therapy during admission had lower RPCP-FI and RPCP-PD. RNFL average thickness was linearly correlated to RPCP-FI and RPCP-PD within post-COVID-19 group. Future studies will be needed to address the hypothesis of a microvascular retinal impairment in individuals who recovered from SARS-CoV-2 infection.

Keywords: OCT angiography; SARS-CoV-2; peripapillary capillary perfusion; personalized medicine.

Figure 1

Optical Coherence tomographic angiography (4.5 × 4.5 mm) centered into the disc in healthy and post COVID-19 patient’s eyes. The yellow arrowhead shows the perfusion defect.

Figure 2

Healthy and post-COVID-19 eyes. Angioanalysis of optic nerve head analysis (ONH = optic nerve head Angiography, 4.5 × 4.5 mm). Lower RPCP-PD value in post-COVID-19 eyes compared to the healthy group (p < 0.04) was observed.

Figure 3

Linear correlation between RNFL (Retinal nerve fiber layer) average thickness and RPCP (Radial peripapillary capillary plexus) perfusion density within post-COVID-19 group patients.

Figure 4

Linear correlation between RNFL (Retinal nerve fiber layer) average thickness and RPCP (Radial peripapillary capillary plexus) flow index within post-COVID-19 group patients.