Seeking clarity on retinal findings in patients with COVID-19
Authors: Camilo Brandão-de-Resende, Alberto Diniz-Filho, Daniel V Vasconcelos-Santos
Journal: The Lancet (2020)

We read with enthusiasm about retinal changes in patients with COVID-19 symptoms, reported by 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 The COVID-19 pandemic is a global health emergency challenging citizens, health authorities, and scientists.2Lippi G Sanchis-Gomar F Henry BM Coronavirus disease 2019 (COVID-19): the portrait of a perfect storm.Ann Transl Med. 2020; 8: 497Crossref Google Scholar The academic response to the pandemic has been amazing. However, many questions remain unanswered. The prospect of characterising retinal changes in patients with COVID-19 is promising. Retinal changes have been reported for other emerging viral disorders, including chikungunya, dengue fever, Zika, Ebola virus disease, and yellow fever, among others.3Oliver GF Carr JM Smith JR Emerging infectious uveitis: chikungunya, dengue, Zika and Ebola: a review.Clin Exp Ophthalmol. 2019; 47: 372-380Crossref Scopus (39) Google Scholar Some of these retinal changes might even serve as non-invasive biomarkers of systemic disease, similar to what has been shown for yellow fever.4Brandão-de-Resende C Cunha LHM Oliveira SL et al.Characterization of retinopathy among patients with yellow fever during 2 outbreaks in southeastern Brazil.JAMA Ophthalmol. 2019; 137: 996-1002Crossref Scopus (13) Google Scholar Careful interpretation of novel imaging observations is essential in this context. In addition to microangiopathic changes (indicated by retinal cotton wool spots and microhaemorrhages), which are also seen in other viral conditions,3Oliver GF Carr JM Smith JR Emerging infectious uveitis: chikungunya, dengue, Zika and Ebola: a review.Clin Exp Ophthalmol. 2019; 47: 372-380Crossref Scopus (39) Google Scholar, 4Brandão-de-Resende C Cunha LHM Oliveira SL et al.Characterization of retinopathy among patients with yellow fever during 2 outbreaks in southeastern Brazil.JAMA Ophthalmol. 2019; 137: 996-1002Crossref Scopus (13) Google Scholar 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 report hyper-reflective lesions on optical coherence tomography at the level of the retinal ganglion cell and inner plexiform layers. After carefully analysing these images, we argue that these changes represent oblique sections and cross-sections of perifoveal retinal blood vessels. Our arguments are two-fold. First, these images show the exact location of the perifoveal vascular plexus, which is found in normal retina.5Hogan MJ Alvarado JA Weddell JE Histology of the human eye. WB Saunders, Philadelphia, PA1971Google Scholar Second, the underlying shadowing is consistent with opaque structures such as retinal blood vessels (appendix). Because 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 did not display corresponding near-infrared images, topographical correlation, as we show in the appendix, could not be seen. However, we congratulate the authors on their work and hope that some of their observations are reproduced and further validated in future studies. CB-d-R, AD-F, and DVV-S are co-founders and partners of AIsculapius Intelligent Medicine. Download .pdf (.79 MB) Help with pdf files Supplementary appendix Seeking clarity on retinal findings in patients with COVID-19Reading about Paula M Marinho and colleagues'1 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. Full-Text PDF 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-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