Ophthalmic assessment of an intensive care ward patients in the first and last wave of the COVID-19. Do they have a difference?

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BACKGROUND: The new coronavirus infection (COVID-19) gained the pandemic status in 2020, and despite the fact that since then the virus has become less pathogenic, its virulence has increased by 2023. Well-vascularized organs and tissues, including the retina, represent the target for coronavirus. The etiopathogenesis of COVID-associated retinopathy, first described in 2021, still remains poorly understood, and its forms and occurrence frequency during different periods of the infectious process vary greatly.

AIM: To identify the main characteristics of the COVID-associated retinopathy in patients with moderate and severe COVID-19 course during the acute period of the disease.

MATERIALS AND METHODS: The study, conducted in 2021 (group 1) and 2023 (group 2), included patients with confirmed COVID-19 of moderate to severe course during the first 7 days from the onset of symptoms. Group 1 included 46 people, mean age 65.5 years, and group 2 included 55 people, mean age 69.3 years. The ophthalmologic examination was carried out in the “red zone” and intensive care unit, and included examination of the anterior segment of the eye, indirect ophthalmoscopy, and fundus photography using a portable hand-held digital fundus camera (Smartscope M5, Optomed, Finland). Hypertension, diabetes mellitus, volume of lung damage, invasive mechanical ventilation, and anticoagulant therapy were considered as conditions affecting retinal microcirculation.

RESULTS: The observation groups were homogeneous in terms of gender, age, and concomitant diseases. The incidence of ophthalmoscopic findings in group 1 was 17.3%, and in group 2 — 12.7%. Most often, during the first 7 days of the disease, signs of angiopathy were observed: dilatation of blood vessels, irregularity of their diameter and tortuosity. Among focal changes, there were multiple retinal hemorrhages (6.5% and 3.6%) and cotton wool spots (4.3% and 5.4%). In patients with fundus changes, diabetes mellitus was significantly less common (in group 1, 25% vs. 39%, p < 0.001; in group 2, 28% vs. 44%, p < 0.001), as well as arterial hypertension (in group 1, 55% vs. 66%, p = 0.003; in group 2 28% vs. 83%, p < 0.001). In group 1, there was a higher proportion of patients treated in intensive care unit, as in group 2 (37% vs. 17%, p < 0.001), but in group 2, patients with identified retinal changes were more likely to receive therapeutic doses of anticoagulants (33% vs. 12%, p < 0.001).

CONCLUSION: The main characteristics of COVID-associated retinopathy in patients with moderate to severe COVID-19 during the acute period of the disease are dilatation and pathological tortuosity of the retinal arteries and veins, intraretinal hemorrhages and cotton wool spots. The connection between COVID-associated retinopathy and concomitant to the infectious process cardiovascular conditions has not been established. Retinopathy associated with coronavirus infection, with absolute similarity of clinical manifestations, was significantly more common in 2021 than in 2023.

作者简介

Vadim Turgel

Oftacon Clinic

编辑信件的主要联系方式.
Email: zanoza194@gmail.com
ORCID iD: 0000-0003-3049-1974
俄罗斯联邦, Saint Petersburg

Svetlana Tultseva

Academician I.P. Pavlov First State Medical University

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

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg

参考

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2. Fig. 1. Fundus photo of the right and the left eyes of patient S., 83 years old, group 1, 3rd day of the disease. Noteworthy are the abnormally tortuous retinal arterioles and venules and the irregular vessels caliber along their entire length. In the areas of arteriovenous crossings there are no symptoms indicating mechanical compression of venules, characteristic of hypertensive angiopathy

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3. Fig. 2. Fundus photo of the right and the left eyes of patient L., female, 57 years old, group 1, 7th day of the disease. Dilatation of arterioles and veins with pronounced tortuosity in the left eye

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4. Fig. 3. Ocular fundus photo of the right eye, group 1: а — patient R., female, 79 years old, 5th day of the disease. Dilatation and pathological tortuosity of arterioles and veins, multiple preretinal and some linear intraretinal hemorrhages near the optic disc; b — patient Ts., female, 66 years old, 3rd day of the disease. Dilatation and pathological tortuosity of arterioles and veins, multiple round intraretinal hemorrhages near the optic disc and along the vascular arcades

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5. Fig. 4. Fundus photos of the group 1 patients: a — patient Z., female, right eye, 63 years old, 2nd day of the disease. Along the edge of the optic disc there is a flame-shaped hemorrhage; b — patient S., female, left eye, 59 years old, 1st day of the disease. There is a peripapillary cotton wool spot along the inferior nasal arcade, pathological tortuosity of arterioles and irregular caliber of venules

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6. Fig. 5. Fundus photo of the right and left eyes of patient O., female, 77 years old, group 2, 7th days of the disease. Abnormally tortuous retinal arterioles and venules and irregular caliber of vessels along their entire length are visualized

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7. Fig. 6. Fundus photo of the right and left eyes of patient L., 51 years old, group 2, 2nd day of the disease. Abnormally tortuous retinal arterioles and venules, irregular caliber of vessels along their entire length are visualized, in the right eye there is a perivascular sheathing along the 2nd order arterioles

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8. Fig. 7. Fundus photo of the female patient’s R. left eye, 69 years old, group 2, 6th day of the disease: a — large cotton wool spot along the superior temporal branch of the central retinal artery. At the border of the lesion, in the area of arteriole’s bifurcation, a yellowish embolus is visualized; b — along the inferotemporal branch of the central retinal artery, in the area of bifurcations, there are 2 more yellowish emboli

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9. Fig. 8. Fundus photo of groups 2 patients: a — patient N., female, 64 years old, left eye, 3rd day of the disease. Large fusiform hemorrhage along the superior temporal vascular arcade; b — patient N., male, 81 years old, right eye, 2nd day of the disease. A cotton wool spot at the border of the optic disc, partially covering a 3rd order venule

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10. Fig. 9. Fundus photo of the female patient’s F. right eye, 72 years old, group 2: a — 3rd day of the disease, there is a large intraretinal hemorrhage at the level of the retinal nerve fiber layer along the inferotemporal vascular arcade, a cotton wool spot along the superotemporal vascular arcade, pathological tortuosity of the arterioles and dilatation of the retinal veins; b — 30th day of the disease, complete resorption of the hemorrhage, pathological tortuosity of the arterioles and dilatation of the retinal veins still remain

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