Abstract
Changes in immune and coagulation systems and possible viral spread through the blood–brain barrier have been described in SARS-CoV-2 infection. In this study, we evaluated the possible retinal involvement and ocular findings in severe COVID-19 pneumonia patients. A cross-sectional study was conducted on 46 patients affected by severe COVID-19 who were hospitalized in one intensive care unit (ICU) and in two infectious disease wards, including bedside eye screening, corneal sensitivity assessment and retinography. A total of 43 SARS-CoV-2-positive pneumonia patients affected with COVID-19 pneumonia were included, including 25 males and 18 females, with a median age of 70 years [IQR 59–78]. Except for one patient with unilateral posterior chorioretinitis of opportunistic origin, of whom aqueous tap was negative for SARS-CoV-2, no further retinal manifestation related to COVID-19 infection was found in our cohort. We found 3 patients (7%) with bilateral conjunctivitis in whom PCR analysis on conjunctival swabs provided negative results for SARS-CoV-2. No alterations in corneal sensitivity were found. We demonstrated the absence of retinal involvement in SARS-CoV-2 pneumonia patients. Ophthalmologic evaluation in COVID-19, particularly in patients hospitalized in an ICU setting, may be useful to reveal systemic co-infections by opportunistic pathogens.
Highlights
Changes in immune and coagulation systems and possible viral spread through the blood–brain barrier have been described in severe acute respiratory syndrome (SARS)-CoV-2 infection
Recent data suggest that COVID-19 infection may be associated with changes in immune and coagulation systems and possible viral spread through the blood–brain barrier, with clinical and anatomopathological findings of disseminated intravascular coagulopathy (DIC), the effects of these alterations on the eye, regarding posterior segment involvement, have not been fully elucidated[13,22,23,24]
We conducted a prospective cross-sectional study at the Policlinico Umberto I, a large teaching hospital in Rome (Italy), that included a cohort of patients affected by COVID-19 who were hospitalized in one intensive care unit (ICU) and in two infectious disease wards from April 24 to May 24, 2020
Summary
Changes in immune and coagulation systems and possible viral spread through the blood–brain barrier have been described in SARS-CoV-2 infection. The subfamily of Orthocoronavirinae—in which SARS-CoVs belong to the Betacoronavirus genus—is already known to occasionally affect ocular s tructures[9,10,11,12] Several manifestations, such as uveitis, retinitis and optic neuritis, have been described in animal models of murine and feline species; these findings have never been confirmed in humans[13]. Recent data suggest that COVID-19 infection may be associated with changes in immune and coagulation systems and possible viral spread through the blood–brain barrier, with clinical and anatomopathological findings of disseminated intravascular coagulopathy (DIC), the effects of these alterations on the eye, regarding posterior segment involvement, have not been fully elucidated[13,22,23,24]. The main objective of the present cross-sectional study was to explore the possible retinal involvement in COVID-19 and to provide data on ocular findings from SARS-CoV-2-positive pneumonia patients
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