Retinal vein occlusion in COVID-19: A novel entity

Abstract

Coronavirus disease 2019 (COVID-19) is a form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been declared a pandemic by the World Health Organization (WHO). Ocular manifestations related to COVID-19 are uncommon with conjunctivitis being reported in a few cases. We report a unique case of vasculitic retinal vein occlusion (RVO) secondary to COVID-19 in a 52-year-old patient who presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. All investigations for vasculitis were negative. This case supports the mechanism of thrombo-inflammatory state secondary to the "cytokine-storm" as the pathogenesis for systemic manifestations of COVID-19.

Keywords: COVID-19; SARS-CoV-2; retinal vein occlusion; vasculitis.

Figure 1

Color fundus photograph (CFP) of the left eye demonstrating inferior hemiretinal vein occlusion (HRVO) with superonasal branch retinal vein occlusion (BRVO)

Figure 2

Fundus fluorescein angiogram (FFA) of the left eye showing the presence of dilated tortuous vein in inferior and superonasal quadrants with late phases showing considerable staining and leakage from the vessel walls (Blue arrow). Multiple areas of hypofluorescence are seen which correspond to retinal hemorrhages clinically, suggestive of blocked fluorescence (Yellow arrow). Furthermore, the involved quadrants also illustrated additional areas of hypofluorescence suggestive of capillary non-perfusion (CNP; Blue arrow). The macular region and optic disc also showed hyperfluorescence in late phases suggestive of leakage

Figure 3

(a) Spectral-domain optical coherence tomography (SD-OCT) of the left eye at baseline illustrating the presence of serous macular detachment (Orange arrow; a), cystoid macular edema (cysts located in outer-nuclear-layer (ONL; Blue arrow; a), inner-nuclear-layer (INL; Red arrow; a) and ganglion-cell-layer (GCL; Green arrow; a) and disorganization of retinal-inner-layers (DRIL; Yellow arrow; a). (b) Follow-up SD-OCT at one-month showing complete resolution of SMD and CME, resolving DRIL (Yellow-arrow; b), subfoveal loss of ellipsoid-zone (EZ) and external limiting membrane (ELM; Red arrow; b), and small intraretinal hyperreflective lesions suggestive of intraretinal hemorrhages (ELM; Blue arrow; b)