Epidemic retinitis during the COVID-19 pandemic

Abstract

Purpose: To study the impact of the novel coronavirus disease-2019 (COVID-19) pandemic on incidence, seasonal variation, clinical presentation, and disease outcome of epidemic retinitis (ER) and to compare clinical outcomes with positive and negative COVID-19 serology.

Methods: This is a retrospective, observational study conducted at a tertiary eye care hospital from August 2020 to June 2022. A graph of ER cases against the month of presentation was compared with the graph of the COVID-19 pandemic in the same region. Cases presented before COVID-19 vaccination, with positive COVID-19 serology (Group 1) were compared with cases with negative serology (Group 2).

Results: One hundred and thirty-two cases of ER were seen. The least number of cases were seen during and immediately after the peak of the pandemic (May 2021-August 2021). COVID-19 serology was positive in 13 (22 eyes)/60 (21.6%) unvaccinated cases. Along with COVID-19, positive serology for other ER etiologies was seen in 5/13 cases (38.4%). All patients received oral doxycycline with/without steroids. Groups 1 and 2 included 22 and 21 eyes of 13 cases each. Macular edema resolved in 43.6 and 32 days in groups 1 and 2, respectively. Retinitis resolved at 1 month in both groups. Corrected distant visual acuity was 20/50 and 20/70 at the presentation, which improved to 20/20 and 20/25 in groups 1 and 2, respectively. Mean and median follow-up was 6 months and 4.5 months, respectively, in both groups. No complications or recurrences were seen.

Conclusion: No significant impact of the COVID-19 pandemic on ER was observed.

Keywords: COVID; Coronavirus; epidemic retinitis; multifocal retinitis; neuroretinitis; pandemic; post-fever retinitis; seasonal variation; seropositive.

Figure 1

Fundus photo of the right eye of a patient from group 1 (Case 2, Table 3) shows cotton wool spot-like retinitis lesions along the superior arcade. (a) OCT scan passing through the lesion shows inner retinal hyper-reflectivity with back-shadowing, outer nuclear layer edema, and mild subretinal fluid. (b) Fundus photo of the right eye taken 10 days after the treatment shows resolving retinitis lesions and the formation of a macular fan. (c) OCT scan at the resolution shows an absence of macular edema and the appearance of hard exudates. (d)

Figure 2

Graphical representation of the number of ER patients along the Y-axis and month of presentation along the X-axis shows a rapid increase in the number of cases from August 2020 with a peak in October-November 2020, then a transient gradual decline in December-January 2021, and again raise in February-March 2021 followed by a gradual decline. Note that the least number of cases were presented in May, June, and July 2021. The number again increased from August 2021 to reach the peak in October 2021–January 2022, followed by a gradual decline to form the trough from May 2022 to June 2022

Figure 3

Graphical representation of the number of cases of COVID-19 seen in the state of Karnataka from June 2020 to October 2021. The graph shows the first wave of the pandemic between September 2020 and October 2020, the second wave between May 2021 and June 2021, and the third between January 2022 and February 2022