Consecutive central and branch retinal vein occlusions in the same eye of a young healthy COVID-19 patient: A unique case report

Abstract

Purpose: To report a case of consecutive central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) in the same eye correlated with coronavirus disease (COVID-19) of the otherwise healthy patient.

Observations: A 39-year-old woman with the diagnosis of COVID-19 infection for two weeks presented with a nonischemic central retinal vein occlusion (CRVO) in her right eye. The patient was on low-dose aspirin for anticoagulant prophylaxis (100 mg/day) for a week when the CRVO occurred. She had no history of any systemic risk factors for retinal vein occlusion (RVO) and her systemic evaluation failed to identify an etiology for her unilateral CRVO. While she was on monthly follow-up with no additional treatment, she experienced sudden visual acuity decrease in the same eye four months after the first RVO incident and one month after the cessation of aspirin intake. Her best corrected visual acuity (BCVA) was decreased from 20/25+ to 20/63. Her fundoscopic examination revealed increased intraretinal hemorrhages, dilated tortuous veins in the upper hemifield and macular edema. The central macular thickness measurement by optic coherence tomography was increased from 234 μm to 700 μm. The patient refused to undergo a fundus fluorescein angiography. After the diagnosis of the branch retinal vein occlusion with cystoid macular edema was done, the aspirin prophylaxis was restarted, and she received three intravitreal antivascular endothelial growth factor one month apart for her macular edema. Her BCVA improved to 20/20, and macular edema disappeared without any recurrence during the 6-month follow-up.

Conclusions and importance: To the best of our knowledge, this unique case is the first report of consecutive RVOs in the same eye of a healthy young patient associated with COVID-19. As our case report demonstrated, close follow-up and timely initiation of appropriate treatment could give rise to complete resolution of RVO.

Keywords: Anti-vascular endothelial growth factor; Branch retinal vein occlusion; COVID-19; Central retinal vein occlusion; Macular edema.

Fig. 1

A- A wide-field fundus photography shows the findings of central retinal vein occlusion (CRVO) including significant disc swelling, cotton-wool spots located near the optic nerve head, and increased venular tortuosity and intraretinal hemorrhages in all four quadrants. B- An optical coherence tomography (OCT) imaging of CRVO demonstrates slight diffuse retinal thickening on the nerve fiber layer in the absence of macular thickening.

Fig. 2

Wide-field fundus photography exhibits the findings of branch retinal vein occlusion including intraretinal hemorrhages, dilated tortuous veins in the upper hemifield, mainly in the temporal quadrant with the macular edema.

Fig. 3

The optical coherence tomography (OCT) imaging of subsequent branch retinal vein occlusion shows A- Prominent serous macular detachment and B-Cystoid macular edema involving all retinal layers of the foveal region with the central foveal thickness of 700 μm.

Fig. 4

A series of follow-up optical coherence tomography (OCT) imaging of the macula shows resolution of cystoid macular edema following intravitreal (IV) anti-VEGF injections.A- Decreased serous macular detachment and cystoid macular edema with the central foveal thickness of 275 μm after the first IV anti-VEGF injection. B- Completely disappeared serous macular detachment with the central foveal thickness of 254 μm after the second IV anti-VEGF injection. C-Normal anatomic structure of the macula without edema with the central foveal thickness of 249 μm two months after the third IV anti-VEGF injection.