Seeking clarity on retinal findings in patients with COVID-19

Abstract

Paula M Marinho and colleagues1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (294) Google Scholar described hyper-reflective lesions in ganglion cell and inner plexiform layers on optical coherence tomography (OCT) images from 24 eyes of 12 adults who had symptoms of COVID-19. Marinho and colleagues argued that these lesions could be associated with COVID-19-related neurological events in humans.2Moriguchi T Harii N Goto J et al.A first case of meningitis/encephalitis associated with SARS-Coronavirus-2.Int J Infect Dis. 2020; 94: 55-58Summary Full Text Full Text PDF PubMed Scopus (1235) Google Scholar On the basis of the fundamental principles of OCT, we hold different views as to how the hyper-reflective foci were generated and their relevance to COVID-19. Because of high light absorption and reflection of the retinal blood and vessel walls, retinal blood vessels can be visualised in OCT images as hyper-reflective, tube-like structures with shadows underneath.3Ouyang Y Shao Q Scharf D Joussen AM Heussen FM An easy method to differentiate retinal arteries from veins by spectral domain optical coherence tomography: retrospective, observational case series.BMC Ophthalmol. 2014; 14: 66Crossref PubMed Scopus (14) Google Scholar, 4Rim TH Choi YS Kim SS et al.Retinal vessel structure measurement using spectral-domain optical coherence tomography.Eye (Lond). 2016; 30: 111-119Crossref Scopus (23) Google Scholar Therefore, all hyper-reflective lesions marked out by Marinho and colleagues by arrows in the figure of their Correspondence1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (294) Google Scholar can be adequately explained by normal retinal blood vessels extending into the ganglion cell and inner plexiform layers. In the appendix, we share two OCT images (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) and two infrared fundus images of the same eye from one healthy person. The retinal blood vessels in the infrared fundus images correspond to the hyper-reflective, tube-like structures with obvious shadows in the ganglion cell and inner plexiform layers of the OCT images. In summary, relating the retinal OCT findings of 12 patients to the consequences of COVID-19 is not well validated. Marinho and colleagues1Marinho PM Marcos AAA Romano AC Nascimento H Belfort Jr, R Retinal findings in patients with COVID-19.Lancet. 2020; 3951610Summary Full Text Full Text PDF PubMed Scopus (294) Google Scholar should provide further elaborate analysis and scientific comparison to confirm the hyper-reflective characteristics of the retinas and their conclusion. We declare no competing interests. Download .pdf (.58 MB) Help with pdf files Supplementary appendix Seeking clarity on retinal findings in patients with COVID-19Reading about Paula M Marinho and colleagues'1 retinal findings in patients with COVID-19 was very interesting. Their Correspondence was the first to report on ocular findings, other than conjunctivitis, in patients with COVID-19, and the authors suggest that these retinal findings are probably associated with COVID-19. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19 – Authors' replyWe are thankful for the comments in response to our Correspondence about retinal findings in patients with COVID-19.1 COVID-19 is a challenging new disease that has raised many questions around unusual findings. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19We read with enthusiasm about retinal changes in patients with COVID-19 symptoms, reported by Paula M Marinho and colleagues.1 The COVID-19 pandemic is a global health emergency challenging citizens, health authorities, and scientists.2 The academic response to the pandemic has been amazing. However, many questions remain unanswered. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19We read with interest the Correspondence by Paula M Marinho and colleagues,1 in which they describe retinal findings in patients with COVID-19. We agree that the small cotton wool spots and retinal microhaemorrhages in a subset of these patients represent important findings showing the non-respiratory aspects of COVID-19, which are probably relevant to the neurological findings seen in some patients. Full-Text PDF Retinal findings in patients with COVID-19Coronavirus disease 2019 (COVID-19) has been shown to affect different parts of the body, and ophthalmological changes have been associated with ocular external diseases such as conjuntivitis1. Full-Text PDF Seeking clarity on retinal findings in patients with COVID-19Paula M Marinho and colleagues1 described their retinal and optical coherence tomography findings from 12 adults with recent onset of COVID-19 symptoms. Infection with severe acute respiratory syndrome coronavirus 2 has been increasingly linked to systemic damage beyond that of the respiratory system.2 Therefore, identifying additional sites affected by COVID-19 is crucial. Ocular surface abnormalities, including conjunctivitis,3 are well established manifestations of COVID-19. Marinho and colleagues1 bring attention to the possibility of retinal involvement in COVID-19. Full-Text PDF