Dynamics of retinal changes during COVID-19 in patients with different variants of the angiotensin-converting enzyme gene

Abstract

PURPOSE

Objective: to study the dynamics of retinal changes according to the data of funduscopy, OCT and OCT-angio in patients with different clinical course of COVID-19 in the acute period and one year after recovery, depending on variants of the angiotensin-converting enzyme gene (ACE, rs 4340).

SETTING / VENUE

Venue: Regional Ophthalmological Center, ME «Volyn Regional Clinical Hospital» of Volyn Regional Council, Lutsk, Volyn Region, Ukraine; Filatov Institute of Eye Diseases and Tissue Therapy, Odesa, Odesa region, Ukraine.

METHODS

Material and methods: 94 patients (188 eyes) with different clinical course of COVID-19 were examined: extremely severe; heavy; of moderate severity with decompensated accompanying pathology; of moderate severity with compensated concomitant pathology and their examination during acute period of disease and one year after recovery. The distribution of patients according to variants of the ACE gene was studied. We determined the disrtribution of retinal changes in COVID-19 patients with different variants of the ACE gene. Clinically significant (prethrombosis of the CRV or branches of the CRV, CRVO or brunches of CRVO, vitreous hemorrhage) and insignificant (narrowed retinal vessels, tortuousness and dilatation of retinal venules, petechial and intraretinal hemorrhages, cotton wool spots) retinal changes were diagnosed using portable fundus cameras. One year after recovery, morphometric changes of the retina and choroid were assessed using OCT and OCT-angio. Molecular genetic research of variants of the ACE gene (rs 4340) was carried out by the method of allele-specific PCR. A statistical analysis of the correlations between the course of COVID-19, the presence of retinal changes, morphometric changes of the retina

RESULTS

Results: In 29.6% of patients, variant II of the ACE gene was detected, ID genotype in 50.5%, DD genotype in 19.9%. No statistically significant correlations were found between metabolic status, severity of COVID-19 and different variants of the ACE gene. No differences were found in the distribution of particular types of retinal manifestations in COVID-19 patients with different genotypes of the ACE gene. Instead, an increase (p<0.001) in the risk of clinically significant retinal changes manifestation was found in patients with the DD genotype compared to patients with II and ID genotypes, p<0.05. The DD variant of the ACE gene has also a statistically significant correlation with an increase in the FAZ area, vessels density in the superficial capillary plexus, vessels density in the deep capillary plexus, and with a decrease in the thickness of the subfoveolar choroid in patients 1 year after the recovery from COVID-19 (p<0.001 ).

CONCLUSIONS

Conclusions: the presence of the DD variant of the ACE gene in patients with COVID-19 increases the risk of clinically significant retinal changes manifestation compared to patients with the II and ID variants of the ACE gene (p<0.001). There is a statistically significant correlation (p<0.001) between morphometric changes of retina and choroid in patients with the DD genotype of the ACE gene after recovery from COVID-19, but no correlation was found with variants II and ID of the ACE gene. DD genotype of the ACE gene can be considered as a risk factor for retinal thrombotic microangiopathy during recovery from COVID-19.