Comments on: Retinal vein occlusion in COVID-19: A novel entity.

Abstract

Dear Editor, We read with interest the case report by Sheth JU et al., where they have attributed a retinal vein occlusion (RVO) in a 52-year-old male to COVID-19 infection.[1] We congratulate the authors for the successful management of the case, however, we would like to present the following arguments against considering it a “vasculitic-RVO” or a manifestation of COVID-19. The fundus photograph of the case showed retinal tortuosity, cotton-wool spots, and hemorrhages limited to quadrants drained by the affected veins. Perivascular exudates, cuffing, or sheathing that are typically seen in retinal vasculitis, were missing. Fluorescein angiography (FA) showed vascular staining and posterior pole leak, which is commonly seen in RVO.[2] However, there was no visible discontinuity or segmentation of vessel wall staining and leakage. Hence, the fundus and FA findings were not suggestive of a retinal vasculitis. The SUN Working group, in their first international workshop, did warn about confusing occlusive retinal vasculopathy with vasculitis. We understand that standardized disease-defining guidelines for COVID-19 are still awaited, but COVID-19-related vasculopathy in various organs including retina, have already been described. Most cases have elevated levels of D-dimer, fibrinogen and von Willebrand factor.[345] Toshiaki et al. have reviewed the literature on COVID-19-associated coagulopathy and found that patients can have normal prothrombin and activated partial thromboplastin times, and platelet count. In his editorial, Becker RC has also recommended distinguishing COVID-19-associated vasculopathy from vasculitis.[5] Therefore, in the absence of any signs of systemic or retinal vasculitis, or details of the patient's one week course during hospital admission and unavailability of relevant systemic biomarkers of COVID-19 coagulopathy, the case cannot be considered representative of COVID-19-related retinal findings based solely on a temporal association. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.