Unilateral COVID-19-associated vasculitic central retinal vein occlusion: phlebitis with subhyaloid, intraretinal and subretinal hemorrhages.

Abstract

To describe unilateral vasculitic central retinal vein occlusion (CRVO) in a young adult whose vision problems preceding system symptoms of COVID-19 infection. Observational clinical case report. A 39-year-old immunocompetent male without prior ocular disease presented for vitreoretinal care complaining of decreasing vision in his right eye for two weeks. Headaches, pharyngitis and coughing began four days after his visual symptoms. COVID-19 testing was negative prior to initial vitreoretinal evaluation and positive afterward. Dilated and tortuous major retinal veins in his right eye had prominent perivascular sheathing. A large subhyaloid hemorrhage spanned the macula. Subretinal hemorrhages were present in areas of sheathing and diffuse nerve fiber layer hemorrhages were arrayed in the distribution of the radial peripapillary capillary plexus. Laboratory tests for inflammatory diseases were negative. The patient was hospitalized for COVID-19 pneumonia a few days after his initial vitreoretinal evaluation. Pars plana vitrectomy was performed for persistent subhyaloid hemorrhage eight weeks after his hospitalization. The visual acuity in the patient's right eye improved from CF to 20/30 post-operatively. The patient's findings are consistent with an atypical CRVO which we hypothesize to be of vasculitic origin because of prominent associated retinal phlebitis and venous sheathing. Concomitant subhyaloid, nerve fiber layer and subretinal hemorrhages involved the superficial and deep retinal vascular complexes. The patient's COVID-19-related hospitalization and systemic management delayed surgical management of his subhyaloid hemorrhages but a good visual result was achieved despite persistence of macular preretinal blood for three months.