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Case Reports
. 2023 Jul 24:16:433-442.
doi: 10.2147/IMCRJ.S408306. eCollection 2023.

Retinal Changes After COVID-19 Infection and COVID-19 Vaccination

João Leite  1 , Ana Carolina Abreu  1 , Maria João Furtado  1   2 , Miguel Lume  1
Affiliations
Case Reports

Retinal Changes After COVID-19 Infection and COVID-19 Vaccination

João Leite et al. Int Med Case Rep J. .

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease was first reported in 2019 and was initially associated with respiratory pathology. With the improvement of knowledge about this disease, it was noticed that, among other symptoms, some patients presented visual acuity changes associated with retinal vascular changes, mainly associated with thrombotic phenomena. Later, with the development of vaccines against SARS-CoV-2 disease, cases of visual acuity alterations secondary to thrombotic phenomena were also reported.

Case presentation: In this article, a series of clinical cases with retinal vascular alterations after COVID-19 infection and vaccination are described.

Conclusion: COVID-19 infection and vaccination increase the risk of retinal vascular events. The purpose of this article is to present a set of clinical cases with various manifestations of vascular changes in the retina associated with COVID-19 infection and COVID-19 vaccination observed in the Department of Ophthalmology of Centro Hospitalar Universitário de Santo António, in Porto, Portugal.

Keywords: COVID-19 infection; COVID-19 vaccination; retinal vascular events.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Case Report 1: At presentation: (A) Macular SD-OCT showing a parafoveal hyper-reflective band at the level of inner nuclear layer; (B) FAF showing venous engorgement and a fern-like pattern; (C) AF and ICGA without ischemic areas (time: 1.47.76). At 4th day of symptoms: (D) Macular SD-OCT showing a peripapillary edema and parafoveal subretinal fluid; (E) FAF showing a fern-like pattern at presentation; (F) AF and ICGA with non-perfused areas (time: 2.04.66). At 4th month of symptoms: (G) Macular SD-OCT showing a macular disorganization; (H) FAF with regression of the fern-like pattern; (I) AF and ICGA without ischemic areas (time: 1.52.66).
Figure 2
Figure 2
Case Report 2: At presentation: (A) Retinography with inferior peripapillary pallor and slight periarterial edema; (B) Macular SD-OCT showing an edema of the inner layers of the retina adjacent to the inferior temporal branch of the central retinal artery. At 1st month of symptoms: (C) Macular SD-OCT maintaining an internal retinal edema; (D) AF showing dilation of peripapillary capillaries with ischemic lesions in the inferior temporal artery (time: 1.31.48); (E) 30–2 Visual Field showing the superior scotoma with preserved macula.
Figure 3
Figure 3
Case Report 3: At presentation: (A and B) Retinitis in the upper nasal macular region with intraretinal hemorrhages in retinography; (C) Macular SD-OCT showed macular edema; (D) – AF and ICGA showed an area of contrast diffusion in the superior temporal periarch (time: 1.04.26 and 6.48.54); (E) OCT-A showed area of non-perfusion in the upper nasal macula. At 1st month of symptoms: (F) Retinography with whitish lesion in the upper nasal macula; (G) OCT-A showed area of non-perfusion area in the upper nasal macula; (H) Macular SD-OCT showed macular edema. At 6th month of symptoms: (I) Retinography without hemorrhages or visible area of retinitis: (J and K) Area of vascular reperfusion without contrast diffusion on AF and ICGA (time: 0.27.87) and OCT-A; (L) No macular edema on Macular SD-OCT.
Figure 4
Figure 4
Case Report 4: At presentation: (A) Retinography with superior temporal periarchal hemorrhage; (B and C) No macular edema on Macular SD-OCT but thickening of the inner layers of the retina at the site of bleeding. At 1st year of symptoms: (D) Retinography without hemorrhage; (E) Macular SD-OCT without edema.
Figure 5
Figure 5
Case Report 5: At presentation: (A) Superior hemiretinal hemorrhage on Retinography; (B) Macular SD-OCT with patterned dystrophy of the retinal pigment epithelium but without macular edema; (C) AF with some ischemic areas in the upper retina with some contrast diffusion. At 6th month of symptoms: (D) Rare hemorrhage on Retinography; (E) Macular SD-OCT with patterned dystrophy of the retinal pigment epithelium but without macular edema.
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