Frequency and structure of retinal vessels changes in different clinical course of COVID-19

Abstract

The purpose of our work is to study the frequency and structure of retinal vessels changes by analyzing the fundus photo of patients with different clinical course of COVID-19. After all, it is known that the condition of retinal vessels can be a marker of somatic pathologies such as diabetes mellitus type 1 or 2, hypertension, chronic renal failure and others, and COVID-19 is no exception. Based on this, we can say that the microcirculatory disorders of the eye, according to the condition of the retinal vessels, may depend on the severity of the infectious disease COVID-19, and therefore may be a marker of its course. Venue: Regional Ophthalmological Center, ME «Volyn Regional Clinical Hospital» of Volyn Regional Council, Lutsk, Volyn Region, Ukraine Materials and methods. We examined patients, hospitalized in the infectious department of Volyn Regional Clinical Hospital with a positive PCR test for COVID-19 (106) and patients with asymptomatic COVID-19 confirmed by ELISA test (262). The mean age of patients was 54 ± 6.2 years. Our study is prospective, uncontrolled, cross-sectional, conducted from October 2020 to December 2021. All patients were divided into 4 groups, depending on the clinical manifestations (blood saturation, blood pressure, heart rate, respiratory rate, percentage of lung damage): 1st - extremely severe (34 patients), 2nd - severe (26 patients), 3 -th - moderate (30 patients), 4th - mild (278 patients). We excluded from the study patients who had a history of retinal changes, recorded previously on fundus photo or by optical coherence tomography. Fundus photos were performed by a portable fundus camera Volk Optical. Statistical data processing was performed using the program Statistica, at p <0.05 - the indicators were statistically significant. Results. We have examined 736 eyes and 98 (13.32%) of examined eyes had retinal changes: 17 eye (2.30%) had narrowed retinal vessels, 29 eyes (3.94%) - tortuosity and dilatation of retinal venules, 19 eyes (2.58%) - cotton wool spots, 23 eyes (3.13%) - intraretinal and petechial hemorrhages, 7 eyes (0.95%) - thrombosis of the central retinal vein or thrombosis of the brunch of central retinal vein, 1 eye (0.13%) - prethrombosis of the central retinal vein and 2 eyes (0 , 27%) - hemophthalmos. In the distribution of the mentioned above retinal changes according to the clinical COVID-19 course groups we have the following data: in extremely severe patients were found hemophthalmos, thrombosis of the central retinal vein or thrombosis of the brunch of central retinal vein, in severe patients - thrombosis of the central retinal vein or thrombosis of the brunch of central retinal vein, prethrombosis of the central retinal vein,cotton wool spots, in moderate patients - cotton wool spots, intraretinal and petechial hemorrhages along the retinal vessels, narrowing or tortuosity and dilatation of retinal vessels, in mild patients - dilation of retinal vessels. Conclusions. Our study shows that every 7th -8th patient with COVID-19 have retinal microvascular manifestations. Retinal manifestations include narrowed retinal vessels, tortuous and dilatated retinal venules, cotton wool spots, petechial and intraretinal hemorrhages, thrombosis of the central retinal vein or thrombosis of the brunch of central retinal vein, prethrombosis of the central retinal vein and hemophthalmos. Patients with mild and moderate severity of COVID-19 have dominatedly such retinal microvascular manifestations such as narrowed retinal vessels, tortuous and dilated retinal venules, petechial hemorrhages, cotton wool spots. In patients with severe and extremely severe course of COVID-19 retinal microvascular manifestations are represented by hemophthalmos, prethrombosis of the central retinal vein, thrombosis of the central retinal vein or thrombosis of the brunch of central retinal vein. Therefore, vascular retinal manifestations in COVID-19 are correlated with the severity of this infectious disease and may be a marker of its clinical course.