Hemi- and Central Retinal Vein Occlusion Associated with Coronavirus Disease 2019 Infection in Young Patients without Known Risk Factors

Noy Ashkenazy, Nimesh A. Patel, Jayanth Sridhar, Nicolas A. Yannuzzi, Peter J. Belin, Richard Kaplan, Nikisha Kothari, Gabriel A. Benitez Bajandas, Radha P. Kohly, Roberto Roizenblatt, Alexander Pinhas, Rusdeep Mundae, Richard B. Rosen, Edwin H. Ryan, Allen Chiang, Louis K. Chang, Rahul N. Khurana, Avni P. Finn

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Venous thromboembolic complications have been reported in association with coronavirus disease 2019 (COVID-19) infection. We raised awareness regarding a potential temporal association between COVID-19 infection and retinal vein occlusion (RVO). Design: Multicenter, retrospective, nonconsecutive case series. Subjects: Patients presenting with hemi-RVO (HRVO) or central RVO (CRVO) between March 2020 and March 2021, with confirmed COVID-19 infection, were included. The exclusion criteria were as follows: age >50 years, hypertension, diabetes, glaucoma, obesity, underlying hypercoagulable states, and those requiring intubation during hospitalization. Methods: This was a multicenter, retrospective, nonconsecutive case series including patients presenting with hemi-RVO (HRVO) or central RVO (CRVO) between March 2020 and March 2021, with confirmed COVID-19 infection. The exclusion criteria were as follows: age >50 years, hypertension, diabetes, glaucoma, obesity, underlying hypercoagulable states, and those requiring intubation during hospitalization. Main Outcome Measures: Ophthalmic findings, including presenting and final visual acuity (VA), imaging findings, and clinical course. Results: Twelve eyes of 12 patients with CRVO (9 of 12) or HRVO (3 of 12) after COVID-19 infection were included. The median age was 32 years (range, 18–50 years). Three patients were hospitalized, but none were intubated. The median time from COVID-19 diagnosis to ophthalmic symptoms was 6.9 weeks. The presenting VA ranged from 20/20 to counting fingers, with over half (7 of 12) having a VA of ≥20/40. OCT revealed macular edema in 42% of the eyes; of these, 80% (4 of 5) were treated with anti-VEGF injections. Ninety-two percent (11 of 12) had partial or complete resolution of ocular findings at final follow-up. Four eyes (33%) had retinal thinning, as determined using OCT, by the end of the study interval. The final VA ranged from 20/20 to 20/60, with 11 of the 12 (92%) eyes achieving a VA of ≥20/40 at a median final follow-up period of 13 weeks (range, 4–52 weeks). Conclusions: Although we acknowledge the high seroprevalence of COVID-19 and that a causal relationship cannot be established, we reported this series to raise awareness regarding the potential risk of retinal vascular events due to a heightened thromboinflammatory state associated with COVID-19 infection.

Original languageEnglish (US)
JournalOphthalmology Retina
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • COVID-19
  • Macular edema
  • Retinal vascular disease
  • Retinal vein occlusion
  • Venous thromboembolism

ASJC Scopus subject areas

  • Ophthalmology

Fingerprint

Dive into the research topics of 'Hemi- and Central Retinal Vein Occlusion Associated with Coronavirus Disease 2019 Infection in Young Patients without Known Risk Factors'. Together they form a unique fingerprint.

Cite this