COVID-19 as a new risk factor for the development of acute vascular diseases of the optic nerve and retina

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Abstract

The new coronavirus disease (COVID-19) is a viral respiratory infection accompanied by systemic “endotheliitis”. COVID-19 patients usually encounter changes related to hypercoagulability, hypofibrinolysis, and increased intravascular platelet aggregation. There is also a vascular wall thromboresistance decrease and impaired vasomotor function, which significantly increase the risk of thromboembolic complications. Currently, pathogenic aspects of the relationship between COVID-19 and vascular and inflammatory conditions of the optic nerve and retina are actively investigated. One of the triggers of impaired blood flow in ocular vessels may be a perfusion pressure decrease, observed in the acute period of the infectious process. This is related to both COVID-19 clinical course features and to resuscitation specificity as well. Secondary autoimmune inflammation is being considered as a mechanism of damage to the vascular wall in the post-infectious period. In this publication, possible pathogenic links of these diseases are considered for the first time in a specific context of the example of ischemic optic neuropathy associated with coronavirus infection.

About the authors

Vadim A. Turgel

Academican I.P. Pavlov First St. Petersburg State Medical University

Email: zanoza194@gmail.com
ORCID iD: 0000-0003-3049-1974

postgraduate student

Russian Federation, 6-8 L’va Tolstogo str., Saint Petersburg, 197089

Vladimir A. Antonov

Academican I.P. Pavlov First St. Petersburg State Medical University

Email: antonov@alborada.fi
ORCID iD: 0000-0002-5823-8367

postgraduate student

Russian Federation, 6-8 L’va Tolstogo str., Saint Petersburg, 197089

Svetlana N. Tultseva

Academican I.P. Pavlov First St. Petersburg State Medical University

Email: tultceva@yandex.ru
ORCID iD: 0000-0002-9423-6772
SPIN-code: 3911-0704

MD, Dr. Sci. (Med.)

Russian Federation, 6-8 L’va Tolstogo str., Saint Petersburg, 197089

Fedor E. Shadrichev

St. Petersburg Territorial Diabetology Center

Email: shadrichev_dr@mail.ru
ORCID iD: 0000-0002-7790-9242
SPIN-code: 4465-8381

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Niurguyana N. Grigorieva

St. Petersburg Territorial Diabetology Center

Author for correspondence.
Email: grinur@mail.ru
SPIN-code: 7299-4748

MD, Cand. Sci. (Med.), ophthalmologist

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. OCT of both optic nerve heads, 5 days after first symptoms.There is a significant increase of the retinal nerve fiber layer’s thickness in the peripapillar area of the right eye, protruding of the optic nerve tissue into the vitreous. Morphometric indices of the optic nerve head of the left eye - within the expected range for age

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3. Fig. 2. Fundus photo, 5 days after first symptoms. Right (а) and left (b) eye fundi status. In both eyes, there are signs of non-proliferative diabetic retinopathy: intraretinal hemorrhages, single cotton-wool spots and hard exudates. On the right eye, optic disc edema and paleness with a hemorrhage are present. On the left eye, along the upper nasal vascular arcade, there is a single macroaneurysm surrounded by hard exudates

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4. Fig. 3. OCT of both optic nerve heads, 6 months after the first examination. The neuroretinal rim thickness and that of the retinal nerve fiber layer in the parapapillar area of the right eye are significantly thinned, cup-to-disc ratio is increased up to 0.7. Morphometric indices of the optic nerve head of the left eye - within the expected range for age, without any dynamic changes when compared to the first examination

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5. Fig. 4. Fundus photo, 6 months after the first examination. Right (а) and left (b) eye fundi status. On the right eye, a partial regression of retinal changes, atrophic optic nerve head changes may be noted. Significant angiosclerosis, “copper wire” sign on the 2nd and 3rd range arterioles are present. On the left eye, there is a macroaneurism regression, more retinal hemorrhages in the posterior pole and in the lower periphery

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6. Fig. 5. AngioOCT of the optic nerve head, 6 months after the first examination. Optic nerve head perfusion indices of the right (а) and left (b) eye. Mean values of perfusion density are 32.9 and 40.5 %, respectively

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7. Fig. 6. AngioOCT of the patient, 6 months after the first examination. Vascular density indices (mm/mm2) of the superficial vascular plexus in the macular area of the right (а) and the left (b) eye, and vascular density indices of the parapapillary plexus of the right (c) and the left (d) eye. A decrease in vascular density in all measurement areas on the involved side is noted

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Copyright (c) 2021 Turgel V.A., Antonov V.A., Tultseva S.N., Shadrichev F.E., Grigorieva N.N.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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