Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar:235:98-110.
doi: 10.1016/j.ajo.2021.09.019. Epub 2021 Sep 26.

COVID-19-Related Retinal Micro-vasculopathy - A Review of Current Evidence

Kelvin Yc Teo  1 , Alessandro Invernizzi  2 , Giovanni Staurenghi  3 , Chui Ming Gemmy Cheung  4
Affiliations
Meta-Analysis

COVID-19-Related Retinal Micro-vasculopathy - A Review of Current Evidence

Kelvin Yc Teo et al. Am J Ophthalmol. 2022 Mar.

Abstract

Purpose: To evaluate the occurrence of retinal microvasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who developed coronavirus disease (COVID-19).

Design: Systematic review and meta-analysis.

Methods: The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analyzed in RevMan Web versions 3.3. Quality of evidence was assessed using the National Institute of Health quality assessment tool for a case-control study.

Results: Thirty-one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case-control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal microvasculopathy in subjects with COVID-19 compared to controls (odds ratio [95% confidence interval], 8.86 [2.54-27.53], P < .01). Optical coherence tomography angiography (OCTA) revealed reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls.

Conclusions: The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might have occurred antecedent to clinically visible changes and could be detected earlier by OCTA. These findings are significant, due to the large numbers with COVID-19, and need to be recognized by ophthalmologists as a potential long-term sequalae of the disease.

Keywords: COVID-19; FAZ; OCTA; SARS-CoV-2; cotton wool spots; retina haemorrhage; retina microvasculopathy; retinopathy; review; vessel density.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Search strategy resulting in 226 records from PubMed.
FIGURE 2
FIGURE 2
Forest plot of odds ratios for retina microvasculopathy in patients with COVID-19 infection versus non-infected controls.
FIGURE 3
FIGURE 3
Forest plot of means of parafoveal vessel density (%) measured on optical coherence tomography angiography in subjects with COVID-19 infection versus non-infected controls.
FIGURE 4
FIGURE 4
Forest plot of means area of foveal avascular zone (mm2) measured on optical coherence tomography angiography in subjects with COVID-19 infection versus non-infected controls.
FIGURE 5
FIGURE 5
Flame hemorrhage (white arrows) and cotton wool spots (white circle) noted on color fundus photograph of a patient with COVID-19.
See this image and copyright information in PMC

References

    1. World Health Organisation; 2019. Coronavirus disease (COVID-2019) situation reports - Situation report 51. Coronavirus disease (COVID-2019) situation reports. online.
    1. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323:1545–1546. - PubMed
    1. Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46(6):1089–1098. - PMC - PubMed
    1. Klok F, Kruip M, Van der Meer N, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res. 2020;191:148–150. - PMC - PubMed
    1. Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020;18(7):1743–1746. - PMC - PubMed

Publication types