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Araujo-Silva CA, Marinho PM, Marcos AAA, Branco AMC, Sakamoto V, Matuoka ML, Moraes NF, Tierno PFGMM, Mourad WM, Nascimento H, Burnier M, de Souza W, Belfort R. Postmortem Ultrastructural Analysis of the Retina from COVID-19 Deceased Patients. Ocul Immunol Inflamm 2023:1-9. [PMID: 37552861 DOI: 10.1080/09273948.2023.2238817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE COVID-19 (coronavirus disease 2019) is an infectious disease caused by SARS-CoV-2, first reported in 2019 in Wuhan, China. Among the common complications is a pro-inflammatory and hypercoagulative response that compromises the vasculature among various organs. METHODS In this report, we present the postmortem retinal findings of five patients observed by means of optical microscopy and transmission and scanning electron microscopy techniques. RESULTS Clinical manifestations such as retinal hemorrhages and exacerbated inflammatory infiltrate, altered ultra structure with swollen mitochondria and pyknotic cells in both layers of the retina were observed in all analyzed eyes. CONCLUSION Our data point to the fragility of this tissue in cases of severe COVID-19.
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Affiliation(s)
- Carlla A Araujo-Silva
- Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens - INBEB, Rio de Janeiro, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagens - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Mateus L Matuoka
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | - Nara F Moraes
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | | | - Walid M Mourad
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Heloisa Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | - Miguel Burnier
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens - INBEB, Rio de Janeiro, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagens - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
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Marinho PM, Marcos AAA, Branco AMC, Mourad WM, Sakamoto V, Romano AC, Farah M, Rosen RB, Schor P, Abraao P, Nascimento H, Belfort R. Retinal autofluorescence findings after COVID-19. Int J Retina Vitreous 2021; 7:71. [PMID: 34838147 PMCID: PMC8626712 DOI: 10.1186/s40942-021-00341-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/01/2021] [Indexed: 01/01/2023] Open
Abstract
The main purpose of this study was to investigate the presence of retinal autofluorescence findings in COVID-19 patients. Observational study conducted in São Paulo in 2020. Demographic, medical history, and concomitant events, as well as medications used, hospitalization details, and laboratory test results, were obtained. Patients underwent eye examination and multimodal imaging, including color, red-free, autofluorescence fundus photography and optical coherence tomography. Eighteen patients had autofluorescence findings (6 females; average age 54 years, range 31 to 86 years; 26 eyes). Hyper-autofluorescence findings were present in 6 patients, Hypo-autofluorescence in 14 patients, and 6 patients had mixed pattern lesions. Retinal autofluorescence abnormalities were present in COVID-19 patients and may be secondary to primary or secondary changes caused by the SARS-CoV-2.
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Affiliation(s)
- Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil. .,Vision Institute - IPEPO, São Paulo, Brazil.
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil.,Young Leadership Program, National Academy of Medicine, Rio de Janeiro, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil
| | - Walid M Mourad
- Vision Institute - IPEPO, São Paulo, Brazil.,Santo Amaro University, São Paulo, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil
| | - Andre C Romano
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
| | - Michel Farah
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Paulo Schor
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
| | - Paulo Abraao
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil
| | - Heloisa Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil.,Young Leadership Program, National Academy of Medicine, Rio de Janeiro, Brazil
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
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Araujo-Silva CA, Marcos AAA, Marinho PM, Branco AMC, Roque A, Romano AC, Matuoka ML, Farah M, Burnier M, Moraes NF, Tierno PFGMM, Schor P, Sakamoto V, Nascimento H, de Sousa W, Belfort R. Presumed SARS-CoV-2 Viral Particles in the Human Retina of Patients With COVID-19. JAMA Ophthalmol 2021; 139:1015-1021. [PMID: 34323931 DOI: 10.1001/jamaophthalmol.2021.2795] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance The presence of the SARS-CoV-2 virus in the retina of deceased patients with COVID-19 has been suggested through real-time reverse polymerase chain reaction and immunological methods to detect its main proteins. The eye has shown abnormalities associated with COVID-19 infection, and retinal changes were presumed to be associated with secondary microvascular and immunological changes. Objective To demonstrate the presence of presumed SARS-CoV-2 viral particles and its relevant proteins in the eyes of patients with COVID-19. Design, Setting, and Participants The retina from enucleated eyes of patients with confirmed COVID-19 infection were submitted to immunofluorescence and transmission electron microscopy processing at a hospital in São Paulo, Brazil, from June 23 to July 2, 2020. After obtaining written consent from the patients' families, enucleation was performed in patients deceased with confirmed SARS-CoV-2 infection. All patients were in the intensive care unit, received mechanical ventilation, and had severe pulmonary involvement by COVID-19. Main Outcomes and Measures Presence of presumed SARS-CoV-2 viral particles by immunofluorescence and transmission electron microscopy processing. Results Three patients who died of COVID-19 were analyzed. Two patients were men, and 1 was a woman. The age at death ranged from 69 to 78 years. Presumed S and N COVID-19 proteins were seen by immunofluorescence microscopy within endothelial cells close to the capillary flame and cells of the inner and the outer nuclear layers. At the perinuclear region of these cells, it was possible to observe by transmission electron microscopy double-membrane vacuoles that are consistent with the virus, presumably containing COVID-19 viral particles. Conclusions and Relevance The present observations show presumed SARS-CoV-2 viral particles in various layers of the human retina, suggesting that they may be involved in some of the infection's ocular clinical manifestations.
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Affiliation(s)
- Carlla A Araujo-Silva
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens-INBEB, Rio de Janeiro, Brazil.,Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Centro Nacional de Biologia Estrutural e Bioimagens-CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil.,Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Alexandre Roque
- Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - André C Romano
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Mateus L Matuoka
- Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - Michel Farah
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | | | - Nara F Moraes
- Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | | | - Paulo Schor
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Heloisa Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil.,Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - Wanderley de Sousa
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens-INBEB, Rio de Janeiro, Brazil.,Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Centro Nacional de Biologia Estrutural e Bioimagens-CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
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Marinho PM, Marcos AAA, Branco AMC, Romano AC, Sakamoto V, Matuoka ML, Moraes NF, Roque A, Tierno PFGMM, Ferreira PRA, Mourad WM, Schor P, Farah M, Rosen RB, Belfort R, Moraes Do Nascimento H. COVID-19 Retinal Findings in Patients Admitted to Intensive Care Units and Wards. Ocul Immunol Inflamm 2021; 29:705-708. [PMID: 33978538 DOI: 10.1080/09273948.2021.1912362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The main purpose of this study was to investigate ocular clinical findings in patients with confirmed COVID-19 infection, of various levels of disease severity, who required mechanical ventilation and admission to intensive care units or specialized wards. Longitudinal, observational study conducted from March 2020 to June 2020. Color fundus and red-free photography were performed in both eyes following pupillary dilation. 104 participants were recruited from 2 different centers: 60 (58%) from the Hospital Municipal de Barueri intensive care unit (ICU) and 44 (42%) from specialized wards for patients with COVID-19 at the Hospital São Paulo. 21.9% presented with eye lesions, in 3% these lesions were vision compromising. Our results have shown similar rate of intraocular lesions in patients in both the ward or intensive care unit, regardless of medication use, including anticoagulant drugs.
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Affiliation(s)
- Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - André C Romano
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - Mateus L Matuoka
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Nara F Moraes
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil
| | - Alexandre Roque
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil
| | - Paulo F G M M Tierno
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil
| | - Paulo R A Ferreira
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - Walid M Mourad
- Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Paulo Schor
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Michel Farah
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Richard B Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Heloisa Moraes Do Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
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Marinho PM, Marcos AA, Branco AMPC, Sakamoto V, Romano A, Schor P, Farah ME, Nascimento H, Belfort R. Results from the SERPICO-19 study - the role of retinal evaluation and in vivo vascular assessment in COVID-19. EClinicalMedicine 2020; 29:100655. [PMID: 33251502 PMCID: PMC7678456 DOI: 10.1016/j.eclinm.2020.100655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Paula M. Marinho
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Allexya A.A. Marcos
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | | | - Victoria Sakamoto
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - André Romano
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Paulo Schor
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Michel E. Farah
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Heloisa Nascimento
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
- Corresponding author. Present address: Vision Institute and Federal, University of São Paulo, Rua Botucatu, 822. São Paulo, Brazil.
| | - Rubens Belfort
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
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