MYTHS AND TRUTHS OF THE ASSOCIATION OF RETINAL VASCULAR OCCLUSION WITH COVID-19

PURPOSE

To critically review data published in the recent past to scrutinize a causal relationship between retinal vascular occlusion and COVID-19.

METHOD

A comprehensive literature search was performed on Pubmed with the key words retinal vascular occlusion, retinal vein occlusion, retinal artery occlusion, and COVID-19.

RESULTS

A total of 17 case reports were published during this period, and 10 were on retinal vein occlusion and 7 on retinal artery occlusion. Most of the published reports lacked convincing evidences in one or the other aspects, such as insufficient laboratory workup or presence of multiple confounding risk factors.

CONCLUSION

In this index article, strength of the data is insufficient to establish a definitive cause-and-effect relationship of retinal vascular occlusive disorders with COVID-19. Hence, clinicians can continue to manage these cases according to the standard guidelines until there are more robust evidences to support this association to alter the diagnostic and treatment modalities.

CHARACTERIZING COVID-19-RELATED RETINAL VASCULAR OCCLUSIONS: A Case Series and Review of the Literature

PURPOSE

To describe clinical and ophthalmologic features and outcomes of patients with coronavirus disease-19 with retinal vascular occlusions.

METHODS

Retrospective multicenter case series and PubMed review of cases reported from March 2020 to September 2021. Outcome measures are as follows: type of occlusion, treatments, best-corrected visual acuity, and central macular thickness on optical coherence tomography.

RESULTS

Thirty-nine patients were identified. Fifteen patients with a median age of 39 (30-67) years were included in the multicenter study. Vascular occlusions included central retinal vein occlusion (12 eyes), branch retinal vein occlusion (4 eyes), and central retinal artery occlusion (2 eyes). Three cases were bilateral. Baseline best-corrected visual acuity was 20/45 (no light perception-20/20). Baseline central macular thickness was 348.64 (±83) μm. Nine eyes received anti-vascular endothelial growth factor agents, dexamethasone intravitreal implant, or both. Final best-corrected visual acuity was 20/25 (no light perception-20/20), and central macular thickness was 273.7 ± 68 μm (follow-up of 19.6 ± 6 weeks). Among the 24 cases from the literature review, retinal vein occlusion was the predominant lesion. Clinical characteristics and outcomes were similar to those found in our series.

CONCLUSION

Coronavirus disease-19-associated retinal vascular occlusions tend to occur in individuals younger than 60 years. Retinal vein occlusion is the most frequent occlusive event, and outcomes are favorable in most cases.

Central retinal vein occlusion caused by human herpesvirus 6

We describe a 1-year-old girl with central retinal vein occlusion caused by human herpesvirus 6. She received systemic corticosteroid therapy. Although there was retinal recovery after the therapy, the visual acuity in her left eye still could not be measured.

Optic neuropathy and central retinal vascular obstruction as initial manifestations of acute retinal necrosis

BACKGROUND

The purpose of this brief communication is to alert ophthalmologists that optic neuropathy may herald acute retinal necrosis (ARN).

CASE

A previously healthy 54-year-old man exhibited optic neuropathy as an initial presentation of ARN, 8 weeks after varicella-zoster dermatitis.

OBSERVATIONS

Central retinal vascular obstruction developed subsequently in his left eye. Later, the classic presentation of ARN appeared in his contralateral eye. Systemic acyclovir therapy stopped the progression of retinitis and resulted in healing of retinal lesions in his right eye.

CONCLUSIONS

This case suggests that optic neuropathy, especially with preceding herpetic dermatitis, should be suspected as the prodrome of ARN.

Coincidence of cytomegalovirus retinitis and central retinal vein occlusion in a patient with hemophilia B and AIDS

A 37-year-old man with hemophilia B, acquired immunodeficiency syndrome, and a unilateral cytomegalovirus retinitis developed a central retinal vein occlusion. This vascular complication occurred despite effective antiviral drug treatment with improvement of the fundus and despite decreased blood coagulability due to hemophilia B. Additional analyses of thrombophilic parameters did not reveal hints of systemic thrombophilia, suggesting that toxic and inflammatory effects of cytomegalovirus itself were responsible for the ophthalmologic aggravation.