Seeking clarity on retinal findings in patients with COVID-19
Authors: Pradeep Venkatesh
Journal: The Lancet (2020)

Reading about Paula M Marinho and colleagues'1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (370) Google Scholar retinal findings in patients with COVID-19 was very interesting. Their Correspondence was the first to report on ocular findings, other than conjunctivitis, in patients with COVID-19, and the authors suggest that these retinal findings are probably associated with COVID-19. To support their suggestion, Marinho and colleagues cite reports of retinitis and optic neuritis in animal models and one case report of meningitis and encephalitis in a patient with suspected COVID-19.2Wang Y Detrick B Yu ZX Zhang J Chesky L Hooks JJ The role of apoptosis within the retina of coronavirus-infected mice.Invest Ophthalmol Vis Sci. 2000; 41: 3011-3018PubMed Google Scholar, 3Moriguchi T Harii N Goto J et al.A first case of meningitis/encephalitis associated with SARS-coronavirus-2.Int J Infect Dis. 2020; 94: 55-58Summary Full Text Full Text PDF PubMed Scopus (1434) Google Scholar However, in these referenced animal models, the infective dose of murine coronavirus (5 μL of 1 × 105·5 median tissue culture infective dose per mL of JHM virus, a strain of mouse hepatitis coronavirus) was directly inoculated into the vitreous cavity, and the patient with meningitis and encephalitis had an atypical presentation with negative blood serology for COVID-19. Marinho and colleagues1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (370) Google Scholar noted the presence of dyspnoea in all 12 patients, and the retinal lesions were bilateral and characteristically distributed in close relation to the nerve fibre layer. The nerve fibre layer is supplied and maintained by the radial peripapillary capillary plexus.4Campbell JP Zhang M Hwang TS et al.Detailed vascular anatomy of the human retina by projection-resolved optical coherence tomography angiography.Sci Rep. 2017; 742201Crossref PubMed Scopus (596) Google Scholar The radial peripapillary capillary plexus is one of the four retinal vascular plexuses and has unique characteristics.4Campbell JP Zhang M Hwang TS et al.Detailed vascular anatomy of the human retina by projection-resolved optical coherence tomography angiography.Sci Rep. 2017; 742201Crossref PubMed Scopus (596) Google Scholar Vessels in the radial peripapillary capillary plexus are long and straight with infrequent anastomoses, run in parallel with the nerve fibre layer, and are present only in the posterior retina.5Jia Y Simonett JM Wang J et al.Wide-field OCT angiography investigation of the relationship between radial peripapillary capillary plexus density and nerve fiber layer thickness.Invest Ophthalmol Vis Sci. 2017; 58: 5188-5194Crossref PubMed Scopus (58) Google Scholar The nerve fibre layer is prone to ischaemic damage. Hence, acute and transient ischaemia of the nerve fibre layer, owing to hypoxia-related autonomic dysregulation of the radial peripapillary capillary plexus, seems like another and more probable cause of the reported retinal lesions. Measurements of arterial blood gas and the partial pressure of oxygen and data on longitudinal follow-up would help to decipher the cause and pathogenesis of these lesions. I declare no competing interests. Seeking clarity on retinal findings in patients with COVID-19 – Authors' replyWe are thankful for the comments in response to our Correspondence about retinal findings in patients with COVID-19.1 COVID-19 is a challenging new disease that has raised many questions around unusual findings. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19We read with enthusiasm about retinal changes in patients with COVID-19 symptoms, reported by Paula M Marinho and colleagues.1 The COVID-19 pandemic is a global health emergency challenging citizens, health authorities, and scientists.2 The academic response to the pandemic has been amazing. However, many questions remain unanswered. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19Paula M Marinho and colleagues1 described hyper-reflective lesions in ganglion cell and inner plexiform layers on optical coherence tomography (OCT) images from 24 eyes of 12 adults who had symptoms of COVID-19. Marinho and colleagues argued that these lesions could be associated with COVID-19-related neurological events in humans.2 On the basis of the fundamental principles of OCT, we hold different views as to how the hyper-reflective foci were generated and their relevance to COVID-19. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19We read with interest the Correspondence by Paula M Marinho and colleagues,1 in which they describe retinal findings in patients with COVID-19. We agree that the small cotton wool spots and retinal microhaemorrhages in a subset of these patients represent important findings showing the non-respiratory aspects of COVID-19, which are probably relevant to the neurological findings seen in some patients. Full-Text PDF Retinal findings in patients with COVID-19Coronavirus disease 2019 (COVID-19) has been shown to affect different parts of the body, and ophthalmological changes have been associated with ocular external diseases such as conjuntivitis1. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19Paula M Marinho and colleagues1 described their retinal and optical coherence tomography findings from 12 adults with recent onset of COVID-19 symptoms. Infection with severe acute respiratory syndrome coronavirus 2 has been increasingly linked to systemic damage beyond that of the respiratory system.2 Therefore, identifying additional sites affected by COVID-19 is crucial. Ocular surface abnormalities, including conjunctivitis,3 are well established manifestations of COVID-19. Marinho and colleagues1 bring attention to the possibility of retinal involvement in COVID-19. Full-Text PDF