Retinal Microvascular Changes in COVID-19 Bilateral Pneumonia Based on Optical Coherence Tomography Angiography

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Jul 9

PMID 35806907

Authors

Magdalena Kal

Mateusz Winiarczyk

Elzbieta Ciesla

Bernadetta Platkowska-Adamska

Anna Walczyk

Michal Biskup

Pawel Pabjan

Stanislaw Gluszek

Dominik Odrobina

Jerzy Mackiewicz

Dorota Zarebska-Michaluk

Affiliations

Soon will be listed here.

Abstract

The purpose of this study was to evaluate retinal and choroidal microvascular alterations with optical coherence tomography angiography (OCTA) in COVID-19 patients hospitalized because of bilateral pneumonia caused by SARS-CoV-2. The vessel density (VD) and foveal avascular zone (FAZ) of 63 patients with SARS-CoV-2 pneumonia who had positive polymerase chain reaction (PCR) tests and who recovered after receiving treatment and 45 healthy age- and gender-matched controls were evaluated and compared using OCTA in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). The VD was also estimated in both groups in the choriocapillaris (CC). In COVID-19 patients, there was a statistically significant difference between the patients and a control group in both superficial (FAZs) and deep (FAZd) avascular zone ( = 0.000). The VD was significantly lower in the foveal area in choriocapillaris ( = 0.046). There were no statistically significant changes in the VD in the superior, inferior, nasal, and temporal quadrants in superficial and deep plexus, or in the choriocapillaris. The VD was not significantly lower in the foveal area in superficial or deep plexus. COVID-19 may affect the retinal vasculature, causing ischemia, enlargement of the FAZ, and lowering of the VD in the choriocapillaris area. Routine ophthalmic examination after SARS-CoV-2 infection should be considered in the course of post-infectious rehabilitation.

Citing Articles

COVID-19's effects on microvascular structure in a healthy retina: an OCTA study.

Kiratli K, Kahraman H, Guven Y, Akay F, Aysin M Int J Ophthalmol. 2025; 18(2):283-289.

PMID: 39967966 PMC: 11754037. DOI: 10.18240/ijo.2025.02.12.

Difference in Optical Coherence Tomography Angiography Parameters After SARS-CoV-2 Infection During the Alpha and Delta Variant Dominance Periods.

Kal M, Brzdek M, Karska-Basta I, Rzymski P, Pinna A, Mackiewicz J Viruses. 2025; 17(1).

PMID: 39861835 PMC: 11769401. DOI: 10.3390/v17010047.

Spectrum of retinal microvascular ischemia in patients with COVID-19 based on multimodal imaging.

Zhang M, Sun J, Wang C, Su L, Chen J, Wang Y Heliyon. 2024; 10(19):e38535.

PMID: 39430536 PMC: 11489334. DOI: 10.1016/j.heliyon.2024.e38535.

A Blood Supply Pathophysiological Microcirculatory Mechanism for Long COVID.

Koutsiaris A Life (Basel). 2024; 14(9).

PMID: 39337860 PMC: 11433432. DOI: 10.3390/life14091076.

Retinal and Corneal OCT Results of Patients Hospitalized and Treated in the Acute Phase of COVID-19.

Wylegala E, Prus-Ludwig A, Mocek P, Tomczyk T, Dugiello B, Madej A J Clin Med. 2024; 13(18).

PMID: 39337050 PMC: 11432357. DOI: 10.3390/jcm13185564.

References

Senanayake P, Drazba J, Shadrach K, Milsted A, Rungger-Brandle E, Nishiyama K . Angiotensin II and its receptor subtypes in the human retina. Invest Ophthalmol Vis Sci. 2007; 48(7):3301-11. DOI: 10.1167/iovs.06-1024. View

Lee J, Kim J, Jang H, Kim J, Kang S, Kim J . Optical coherence tomography angiography as a potential screening tool for cerebral small vessel diseases. Alzheimers Res Ther. 2020; 12(1):73. PMC: 7291486. DOI: 10.1186/s13195-020-00638-x. View

Harrison A, Lin T, Wang P . Mechanisms of SARS-CoV-2 Transmission and Pathogenesis. Trends Immunol. 2020; 41(12):1100-1115. PMC: 7556779. DOI: 10.1016/j.it.2020.10.004. View

Hazar L, Karahan M, Vural E, Ava S, Erdem S, Dursun M . Macular vessel density in patients recovered from COVID 19. Photodiagnosis Photodyn Ther. 2021; 34:102267. PMC: 7999941. DOI: 10.1016/j.pdpdt.2021.102267. View

Patton N, Aslam T, MacGillivray T, Pattie A, Deary I, Dhillon B . Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J Anat. 2005; 206(4):319-48. PMC: 1571489. DOI: 10.1111/j.1469-7580.2005.00395.x. View

Giannis D, Ziogas I, Gianni P . Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020; 127:104362. PMC: 7195278. DOI: 10.1016/j.jcv.2020.104362. View

Li M, Li L, Zhang Y, Wang X . Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020; 9(1):45. PMC: 7186534. DOI: 10.1186/s40249-020-00662-x. View

Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S . SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020; 181(2):271-280.e8. PMC: 7102627. DOI: 10.1016/j.cell.2020.02.052. View

Kal M, Winiarczyk M, Gluszek S, Mackiewicz J . Choroidal thickness in lamellar macular holes. Graefes Arch Clin Exp Ophthalmol. 2020; 259(3):653-659. PMC: 7904735. DOI: 10.1007/s00417-020-04922-2. View

10.

Savastano A, Crincoli E, Savastano M, Younis S, Gambini G, Vico U . Peripapillary Retinal Vascular Involvement in Early Post-COVID-19 Patients. J Clin Med. 2020; 9(9). PMC: 7565672. DOI: 10.3390/jcm9092895. View

11.

Szkodny D, Wylegala E, Sujka-Franczak P, Chlasta-Twardzik E, Fiolka R, Tomczyk T . Retinal OCT Findings in Patients after COVID Infection. J Clin Med. 2021; 10(15). PMC: 8347407. DOI: 10.3390/jcm10153233. View

12.

Lee C, Cheng H, Chang F, Wang A . Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting. Sci Rep. 2019; 9(1):14755. PMC: 6791857. DOI: 10.1038/s41598-019-51382-8. View

13.

Fotuhi M, Mian A, Meysami S, Raji C . Neurobiology of COVID-19. J Alzheimers Dis. 2020; 76(1):3-19. PMC: 7660990. DOI: 10.3233/JAD-200581. View

14.

Samara W, Say E, Khoo C, Higgins T, Magrath G, Ferenczy S . CORRELATION OF FOVEAL AVASCULAR ZONE SIZE WITH FOVEAL MORPHOLOGY IN NORMAL EYES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina. 2015; 35(11):2188-95. DOI: 10.1097/IAE.0000000000000847. View

15.

Marinho P, Marcos A, Romano A, Nascimento H, Belfort Jr R . Retinal findings in patients with COVID-19. Lancet. 2020; 395(10237):1610. PMC: 7217650. DOI: 10.1016/S0140-6736(20)31014-X. View

16.

Holappa M, Vapaatalo H, Vaajanen A . Many Faces of Renin-angiotensin System - Focus on Eye. Open Ophthalmol J. 2017; 11:122-142. PMC: 5510558. DOI: 10.2174/1874364101711010122. View

17.

Hagag A, Gao S, Jia Y, Huang D . Optical coherence tomography angiography: Technical principles and clinical applications in ophthalmology. Taiwan J Ophthalmol. 2017; 7(3):115-129. PMC: 5617355. DOI: 10.4103/tjo.tjo_31_17. View

18.

Lippi G, Plebani M . Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med. 2020; 58(7):1131-1134. DOI: 10.1515/cclm-2020-0198. View

19.

Courtie E, Veenith T, Logan A, Denniston A, Blanch R . Retinal blood flow in critical illness and systemic disease: a review. Ann Intensive Care. 2020; 10(1):152. PMC: 7661622. DOI: 10.1186/s13613-020-00768-3. View

20.

Araujo-Silva C, Marcos A, Marinho P, Branco A, Roque A, Romano A . Presumed SARS-CoV-2 Viral Particles in the Human Retina of Patients With COVID-19. JAMA Ophthalmol. 2021; 139(9):1015-1021. PMC: 8323055. DOI: 10.1001/jamaophthalmol.2021.2795. View