Eye Fundus Research Articles

Phenotypic heterogeneity in family members of patients with retinitis pigmentosa.

To describe the phenotypic variations in family members of patients with retinitis pigmentosa (RP) with different modes of inheritance and to assess the ocular abnormalities in RP families. A descriptive analysis of three types of inheritance of RP was carried out, where 64 family members were examined at a tertiary eye care center, South India. They underwent comprehensive eye examination, fundus photography, fundus autofluorescence (FAF), full-field electroretinogram (FFERG), and spectral domain optical coherence tomography (SD-OCT). Analysis was performed between mild and severe forms of abnormalities to delineate retinal structural and functional defects in RP families. The mean age was 38.55 ± 17.95 years. Males were 48.4%. In autosomal recessive and X-linked recessive groups, 74.2% and 77.3%, respectively, were asymptomatic, whereas in autosomal dominant group, 27.3% were asymptomatic. The proportion of the cases with abnormalities in all three groups was higher on ERG (59.6%), followed by OCT (57.5%), visual acuity (43.7%), peripheral FAF (23.5%), and macular FAF (11.8%). However, these abnormalities and the clinical pictures of the family members had no statistical difference across the three groups of inheritance. Structural and functional retinal alterations were noted in four out of five asymptomatic members, suggesting the need for careful screening of RP families and the pressing need for pre-test (genetic) counseling.

Diabetic retinopathy detection in eye fundus images using deep transfer learning and robust feature extractors

Diabetic retinopathy detection in eye fundus images using deep transfer learning and robust feature extractors

Counteracting Data Bias and Class Imbalance-Towards a Useful and Reliable Retinal Disease Recognition System.

Multiple studies presented satisfactory performances for the treatment of various ocular diseases. To date, there has been no study that describes a multiclass model, medically accurate, and trained on large diverse dataset. No study has addressed a class imbalance problem in one giant dataset originating from multiple large diverse eye fundus image collections. To ensure a real-life clinical environment and mitigate the problem of biased medical image data, 22 publicly available datasets were merged. To secure medical validity only Diabetic Retinopathy (DR), Age-Related Macular Degeneration (AMD) and Glaucoma (GL) were included. The state-of-the-art models ConvNext, RegNet and ResNet were utilized. In the resulting dataset, there were 86,415 normal, 3787 GL, 632 AMD and 34,379 DR fundus images. ConvNextTiny achieved the best results in terms of recognizing most of the examined eye diseases with the most metrics. The overall accuracy was 80.46 ± 1.48. Specific accuracy values were: 80.01 ± 1.10 for normal eye fundus, 97.20 ± 0.66 for GL, 98.14 ± 0.31 for AMD, 80.66 ± 1.27 for DR. A suitable screening model for the most prevalent retinal diseases in ageing societies was designed. The model was developed on a diverse, combined large dataset which made the obtained results less biased and more generalizable.

Effects of pupil dilation with topical 0.5% tropicamide on retinal vascular parameters assessed by VAMPIRE® software in healthy cats

Our study investigates the effects of mydriasis obtained with topical 0.5% tropicamide on retinal vascular parameters evaluated in cats using the retinal imaging software: Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE®). Forty client-owned healthy adult cats were included in the study. Topical 0.5% tropicamide was applied to dilate only the right pupil. The left eye was used as a control. Before dilation (T0), infrared pupillometry of both pupils was performed and fundus oculi images were taken from both eyes. Right eye fundus images were then captured 30 min after topical application of tropicamide (T30), when mydriasis was achieved. The retinal vessel widths (3 arteries and 3 veins) were measured with VAMPIRE® in four standard measurement areas (SMA) identified with the letters A, B, C, D. Average value of the 3 vessel widths was used. After normality assessment, the t-test was used to analyse the mean difference in vascular parameters of the left and right eyes at T0 and T30, with p set <0.05. The two eyes showed no statistical differences in pupil and vascular parameter measurements at T0. At T30, only one artery measurement of the right eye (SMA A-peripapillary area) showed a small but statistically significant mean vasoconstriction of approximately 4%. The results indicate that local application of 0.5% tropicamide seems to be associated with a small retinal arteriolar vasoconstriction as assessed by VAMPIRE® in cats. However, this change is minimal, and should not affect the interpretation of the results when VAMPIRE® is used.

Früherkennung eines Aderhautmelanoms – ein Fallbericht

Purpose. This case report describes the accidental early detection of a small choroidal melanoma during a routine optometric examination. The following is a report of a rare case of choroidal melanoma, in a 58-year-old male Caucasian. He wanted to have glasses for computer work and complained of occasional flickering, when seeing in the morning after getting up. Material and Methods. The following optometric measure- ment methods were used: confrontation visual field test, ex- traocular muscle function test, cover test, retinoscopy (Heine Beta 200 Retinoscope), refraction, slit lamp examination (slit lamp Zeiss SL 120) with evaluation of the anterior eye, evalua- tion of the posterior eye (Heine Beta 200 Ophthalmoscope) and handheld fundus camera (Zeiss Visuscout 100). Results. On fundus examination of the left eye, a light pigmented retinal lesion with orange pigment and retinal eleva- tion was seen temporally on the upper vascular arch. Due to the suspected diagnosis of choroidal melanoma, immediate contact was made with a local ophthalmology practice. This confirmed the suspicion and the patient was referred to the University Eye Clinic in Munich. Conclusion. Uveal melanoma is the most common intraocular malignancy and arises from melanocytes in the iris, ciliary body or choroid. Early diagnosis and local treatment are crucial, as survival correlates with primary tumor size. Approx- imately 50 percent of patients will develop metastatic disease with survival of 6-12 months after metastatic diagnosis. The University Eye Clinic Munich confirmed the diagnosis of choroidal melanoma. A robotic Cyberknife radiosurgery was performed. Keywords Uveal Melanoma, Choroidal Melanoma, Cyberknife Radio-surgery

Three level automatic segmentation of optic disc using LAB color space contours and morphological operation

AbstractFundus disorders like Glaucoma are a serious health risk that affects people all over the world, lowering their quality of life. Optic disc (OD) segmentation is a crucial step for automatic detection of glaucoma with fundus images. This paper presents an efficient and accurate OD segmentation methodology from eye fundus images. In the proposed methodology, fundus images are transformed from RGB (Red, Green, and Blue) color space to LAB (Luminance, A‐axis, B‐axis) color space. A new image is generated using the luminance, A‐axis component, and image information content. As a pre‐segmentation stage, the unsupervised approach extracts the region of interest containing OD. The adaptive threshold method, followed by morphological operations, extracts the contours of the OD region and removes the spur. Segmentation of OD is a challenging task due to similar intensity levels with neighborhood, vascular occlusion, and retinal atrophy. The proposed work overcomes the challenges by segmentation of the OD at three levels, which enhances the functionality at different illumination conditions. The features are extracted at various levels to determine whether the segmented image contains the OD or not. The efficiency of the proposed methodology demonstrates by applying it to a variety of fundus images from datasets, namely ISBI IDRiD, DRISHTI‐GS, and SYSU. Key performance metrics like Intersection over Union and Dice Coefficient are used to evaluate the performance of the proposed methodology. The proposed methodology achieves Intersection over Union of 0.996, 0.997, and 0.994 on ISBI IDRiD, DRISHTI‐GS, and SYSU datasets, respectively. Similarly, the proposed methodology obtains 0.96, 0.97, and 0.98 Dice Coefficient on the three datasets.

Comparison of Cirrus spectral domain OCT with disc-macula distance to disc diameter ratio in diagnosing congenital optic nerve hypoplasia.

Diagnosis of congenital optic nerve hypoplasia (CONH) can be challenging in children or uncooperative individuals. Misdiagnosis can lead to inappropriate treatment; thus, it is important to identify an objective and reliable measurement. The purpose of this study was to evaluate whether Cirrus spectral domain optical coherence tomography (SD-OCT) is a valid test for diagnosing CONH by comparing it to the disc-macula distance to disc diameter (DM:DD) ratio. A total of 93 participants (64 controls and 29 CONH) underwent comprehensive eye examinations, fundus photography and Cirrus SD-OCT. Receiver operating characteristic (ROC) curves for the DM:DD ratio and OCT disc area were constructed for CONH and control eyes. Mean (±SD) OCT disc area was 1.46 (±0.42) mm2 and 1.89 (±0.38) mm2 for CONH and control eyes, respectively (p < 0.0001). The area under the curve for the DM:DD ratio was 0.97 (95% confidence interval: 0.91-0.99) and 0.79 for OCT disc area (95% confidence interval: 0.70-0.86), which were significantly different (p = 0.0005). The optimal cut-off value for OCT disc area was 1.66 mm2 (76% sensitivity, 70% specificity), while the optimal cut-off for DM:DD ratio was 3.10 (85% sensitivity and 95% specificity). The Cirrus SD-OCT showed a tendency to overestimate disc size, especially in cases with no light perception (NLP) or segmental CONH. Although the DM:DD ratio is superior to OCT in diagnosing CONH with a higher sensitivity and specificity, the ratio is subject to inter-examiner variability and can be challenging to obtain. We found the Cirrus SD-OCT to be a valid objective test for diagnosing CONH. Caution is advised when using SD-OCT in segmental CONH or in an eye with NLP. We suggest 1.66 mm2 as the optimal cut-off value for Cirrus SD-OCT disc area to differentiate a hypoplastic from a normal optic disc.

Retinal Vessel Local Tortuosity under a Macula-to-Optic Disc Central-Framing Change

Some ocular and cardiovascular diseases can be detected through the increased tortuosity of retinal blood vessels. Objective tortuosity measures can be obtained from digital image analysis of a retinography. This study tested a set of local tortuosity indices under a change in the frame center (macula, optic disc) of the eye fundus image. We illustrate the effects of such a change on 40 pairs of vessels evaluated with eight tortuosity indices. We show that the frame center change caused significant differences in the mean values of the vast majority of the tortuosity indices analyzed. The index defined as the ratio of the curvature to the arc length of a vessel segment proved to be the most robust in relation to a frame center change. Experimental results obtained from the analysis of clinical images are provided and discussed.

Two New Geophytic Species of Peperomia Subgenus Tildenia (Piperaceae) from Central Peru

Two new geophytic species of Peperomia subgenus Tildenia (Piperaceae) from Central Peru are described; (1) Peperomia pachyspadix is a new species from Huancavelica. It is phenotypically similar to P. andina from Cajamarca, but its leaves are not as thick and they lack the funnel shape and purple color of the abaxial side; it is also similar to P. wernerrauhii from Huánuco, but its leaves and tubers are larger. The new species can be distinguished from the abovementioned ones by the spadix, many times shorter and twice as thick. The seeds of P. andina, P. wernerrauhii and P. pachyspadix are similar in shape but the latter has the largest of all three. (2) Peperomia fundus-oculi is a new species with epigeous tuber discovered on the eastern Andean slopes of Ayacucho. Plants are morphologically like P. chutanka for its exposed and branched aerial tubers. Its leaves have a shape similar to this species but are not as succulent, they lack the purplish color of the abaxial side, and they have a characteristic pattern on its adaxial side, with a whitish iridescent spot in the center, with irregular margins, from where nerves emerge, giving the impression of the eye fundus, hence its name in Latin. Its anthers, ovaries, and fruits are also shorter than those of P. chutanka.

Disturbances of Ocular Circulation in Color Doppler Imaging, Retinal Changes and Electrophysiological Tests with Neuro-Ophthalmological Clinical Symptoms in the Course of CADASIL Syndrome—A Case Report

The authors present a new paper examining the disturbances in ocular circulation and electrophysiological changes in the presence of neuro-ophthalmic manifestations in a patient with cerebral autosomal dominant arteriopathy with subcortical infracts and leucoencephalopathy (CADASIL). Symptoms reported by the patient included: transient vision loss (TVL), migraines, diplopia, bilateral peripheral visual field loss and convergence insufficiency. CADASIL was confirmed by the presence of NOTCH3 gene mutation (p.Cys212Gly), the presence of granular osmiophilic material (GOM) in cutaneous vessels in an immunohistochemistry test (IHC) and bilateral focal vasogenic lesions in the white matter of the cerebral hemisphere, with micro-focal infarct in the left external capsule on a magnetic resonance imaging test (MRI). Color Doppler imaging (CDI) confirmed decreased blood flow and increased vascular resistance in the retinal and posterior ciliary arteries, with reduced P50 wave amplitude on a pattern electroretinogram (PERG). An eye fundus examination and fluorescein angiography (FA) revealed the constriction of retinal vessels and a peripheral retinal pigment epithelium (RPE) atrophy with focal drusen. The authors suggest that the cause of TVL may be changes in the hemodynamics of the retinochoroid vessels associated with the narrowing of small vessels and the presence of druses in the retina-which is supported by a decrease in the amplitude of the P50 wave in PERG, changes in OCT correlating simultaneously with changes in MRI imaging and other neurological symptoms.

Deep Learning Model for Static Ocular Torsion Detection Using Synthetically Generated Fundus Images.

The objective of the study is to develop deep learning models using synthetic fundus images to assess the direction (intorsion versus extorsion) and amount (physiologic versus pathologic) of static ocular torsion. Static ocular torsion assessment is an important clinical tool for classifying vertical ocular misalignment; however, current methods are time-intensive with steep learning curves for frontline providers. We used a dataset (n = 276) of right eye fundus images. The disc-foveal angle was calculated using ImageJ to generate synthetic images via image rotation. Using synthetic datasets (n = 12,740 images per model) and transfer learning (the reuse of a pretrained deep learning model on a new task), we developed a binary classifier (intorsion versus extorsion) and a multiclass classifier (physiologic versus pathologic intorsion and extorsion). Model performance was evaluated on unseen synthetic and nonsynthetic data. On the synthetic dataset, the binary classifier had an accuracy and area under the receiver operating characteristic curve (AUROC) of 0.92 and 0.98, respectively, whereas the multiclass classifier had an accuracy and AUROC of 0.77 and 0.94, respectively. The binary classifier generalized well on the nonsynthetic data (accuracy = 0.94; AUROC = 1.00). The direction of static ocular torsion can be detected from synthetic fundus images using deep learning methods, which is key to differentiate between vestibular misalignment (skew deviation) and ocular muscle misalignment (superior oblique palsies). Given the robust performance of our models on real fundus images, similar strategies can be adopted for deep learning research in rare neuro-ophthalmologic diseases with limited datasets.

Fabrication of biconvex spherical and aspherical lenses using 3D printing.

In this work, we present the methods of fabrication and characterization of biconvex spherical and aspherical lenses with 25 and 50 mm diameters that have been created via additive technology using a Formlabs Form 3 stereolithography 3D printer. After the prototypes are postprocessed, fabrication errors ≤2.47% for the radius of curvature, the optical power, and the focal length are obtained. We show eye fundus images captured with an indirect ophthalmoscope using the printed biconvex aspherical prototypes, proving the functionality of both the fabricated lenses and the proposed method, which is fast and low-cost.

Dynamics of the State of the Eye Fundus of a Patient with Proliferative Diabetic Retinopathy and End-Stage Chronic Renal Failure after Hemodialysis (Clinical Case)

Purpose. To analyze a clinical case on the study of the dynamics of the state of the fundus of a patient with proliferative diabetic retinopathy (PDR) and end-stage chronic renal failure (CRF) on the background of hemodialysis (HD).Patient and methods. A clinical case of the study of the state of the organ of vision against the background of HD in patient S., 36 years old, is presented. Hemodialysis was performed for 4 months using the Artis Surdial-55 device (Nipro, Japan) for 3.5–4 hours with a blood flow rate of 250 ml/min and a dialysis solution flow rate of 500 ml/min. The severity of PDR was assessed using standard methods based on ultrasound (Opticon 2000, Italy), photographic recording of the state of the eye fundus (Carl Zeiss Visucam 500, Germany) and OCT of the macular region (on an RTVue-100 tomograph, OptoVue, USA).Results and conclusion. Studies before and after a course of HD indicate no changes in the fundus, which is confirmed by the data of an objective examination.

Chemical Ocular Injury: Case Report

Background refers to Oculusnd: A chemical ocular burn is an emergency that requires immediate management. It can occur under various circumstances. Case Presentation: The present case is a 31-year-old female exposed to an instant burst of chemicals that splashed all over her. The patient was presented to the emergency department with an injury to the eye and face. The immediate step for chemical ocular burn was eye irrigation with an isotonic solution before the examination of the eye. Then an examination of the eye, including ocular, slit lamp, and detailed fundus examinations, was done. The acute management of a patient with chemical eye burns included an antibiotic, tear substitutes, agents to control inflammation and support repair as well as cycloplegic therapy. Conclusion: A chemical ocular burn is an ophthalmic emergency that requires immediate management. Eye irrigation with an isotonic solution is the immediate step that should be done for the affected individual. Then an examination of the eye should be performed. Alkali substances cause more severe burns compared to acid substances. The acute management of a patient with chemical eye burns should include antibiotics, tear substitutes, agents to control inflammation, and support repair, as well as cycloplegic therapy.

Optic Nerve Head Melanocytoma Co-existing in a Case of Thyroid Eye Disease: Co-incidence or Cause?

Optic Nerve Head Melanocytoma (ONHM) is a rare benign pigmented tumour of the uveal tract, seen commonly at the optic nerve head. The tumour is associated with a few ocular and systemic conditions. It usually remains stationary and rarely (1-2%) undergoes a malignant transformation. With the progressive understanding of its benign nature with advancing imaging modalities, observation with regular follow-up is the mainstay of treatment. A 35-year-old female, presented with complaints of foreign body sensation in both eyes. She was a known case of graves’ disease under treatment with anti-thyroid drugs and beta blockers. Ocular examination revealed classic signs of thyroid eye disease. The left eye fundus revealed a large, black, globular tumour in the optic nerve head obscuring the entire disc and Ultrasound B scan revealed a tumour at the optic nerve head with high echogenicity. Optical Coherence Tomography (OCT) through the mass revealed a dome-shaped elevation with obscuration of underlying details due to heavy pigmentation, with no signs of subretinal exudation or edema. Thyroid profile was within normal limits. A diagnosis of left eye ONHM was made. The patient was started on tapering doses of systemic steroids and was regularly followed up to monitor the tumour growth for 18 months. This is the first reported case of ONHM co-existing with thyroid eye disease and this association could be coincidental or embryological. This case highlights the need for ophthalmologists to be familiar with this benign condition and for regular careful follow-up of such patients.

A deep-learning model for the assessment of coronary heart disease and related risk factors via the evaluation of retinal fundus photographs

Objective: To develop and validate a deep learning model based on fundus photos for the identification of coronary heart disease (CHD) and associated risk factors. Methods: Subjects aged>18 years with complete clinical examination data from 149 hospitals and medical examination centers in China were included in this retrospective study. Two radiologists, who were not aware of the study design, independently evaluated the coronary angiography images of each subject to make CHD diagnosis. A deep learning model using convolutional neural networks (CNN) was used to label the fundus images according to the presence or absence of CHD, and the model was proportionally divided into training and test sets for model training. The prediction performance of the model was evaluated in the test set using monocular and binocular fundus images respectively. Prediction efficacy of the algorithm for cardiovascular risk factors (e.g., age, systolic blood pressure, gender) and coronary events were evaluated by regression analysis using the area under the receiver operating characteristic curve (AUC) and R2 correlation coefficient. Results: The study retrospectively collected 51 765 fundus images from 25 222 subjects, including 10 255 patients with CHD, and there were 14 419 male subjects in this cohort. Of these, 46 603 fundus images from 22 701 subjects were included in the training set and 5 162 fundus images from 2 521 subjects were included in the test set. In the test set, the deep learning model could accurately predict patients' age with an R2 value of 0.931 (95%CI 0.929-0.933) for monocular photos and 0.938 (95%CI 0.936-0.940) for binocular photos. The AUC values for sex identification from single eye and binocular retinal fundus images were 0.983 (95%CI 0.982-0.984) and 0.988 (95%CI 0.987-0.989), respectively. The AUC value of the model was 0.876 (95%CI 0.874-0.877) with either monocular fundus photographs and AUC value was 0.885 (95%CI 0.884-0.888) with binocular fundus photographs to predict CHD, the sensitivity of the model was 0.894 and specificity was 0.755 with accuracy of 0.714 using binocular fundus photographs for the prediction of CHD. Conclusion: The deep learning model based on fundus photographs performs well in identifying coronary heart disease and assessing related risk factors such as age and sex.

Retinal and intracranial arteriovenous malformations in Wyburn–Mason syndrome

A 12-year-old female presented with left exotropia for 1 year. The left eye fundus revealed dilation and tortuosity of the retinal arteries and veins consistent with group 3 retinal arteriovenous malformation (AVM; Fig. 1A). Fundus fluorescein angiography showed AVM filling without leakage but with a temporal nonperfusion area (Fig. 1B). Magnetic resonance angiogram of the head and cerebral angiography showed left orbital and suprasellar AVMs (Fig. 1C, D). The patient was diagnosed with Wyburn–Mason syndrome. No treatment was recommended for the intracranial AVMs because of the associated surgical risk to the perforators and the visual pathway.

Prevention campaign for amblyopia and other eye disorders among schoolchildren

AbstractPurpose: This is a retrospective longitudinal observational study to detect amblyopia and other visual anomalies (refraction, strabismus, pathologies…) in 3, 4 and 5‐year‐old schoolchildren. Amblyopia is a disorder of sight in which the brain fails to fully process input from one eye and over time favours the other eye. It results in decreased vision in an eye that typically appears normal in other respects. Early detection improves treatment success. There is currently an early detection program but according to a recently published study, does not have good compliance or appropriate material.Methods: The study was carried out with children aged 4–6 years from 4 different schools, collecting 491 children with the corresponding informed consent of their parents. The study was divided into two phases, first an optometrist performed an external examination, red reflex, pupillary examination, ocular motility, cover test and photoscreening with a portable autorefractometer. And if any anomaly is detected in the second phase, it would be explored by an ophthalmologist who would also perform stereopsis tests, visual acuity, dilated refraction, eye fundus, and diagnosis and treatment.Results: 491 children were included in this study, visual anomalies were detected in 96, of which 60 were studied in our center. It was detected 47% who had refractive problems, 5% strabismus and 0% opacities. Extrapolating it to the total number of patients seen, 9% had refractive problems and 1% strabismus.Conclusions: Amblyopia has a prevalence of 6% in the population. Its treatment is relatively simple with glasses and patches at a low cost. There is a prevalence of 5%–7.5% of amblyopia in &lt;6 years, 1%–3% strabismus in &lt;6 years as well as 1 of 3 school failure is caused by visual problem.Paediatric check‐up or other check‐ups that these schoolchildren do not detect this type of condition. Therefore, the Campaign for the Prevention of Amblyopia and Other Visual Anomalies idea should be implemented in all the Autonomous Communities.Reference1. Eileen E Birch. Amblyopia and binocular vision. Prog Retin Eye Res. 2013; 33: 67–84.

Surgical management of disc pit maculopathy: A case report

AbstractPurpose: Optic disc pit (ODP) is a rare congenital disorder that affects one in 10 000 people. Serous detachment of macula is the most common complication and the natural history of untreated ODP maculopathy is a gradual deterioration with significant visual loss. A multitude of interventions have been designed for the treatment but none has been established as the treatment of choice. Pars plana vitrectomy is one of the most commonly used procedure in recent years. We present a case report with surgical treatment and management of complications.Methods: An interventional case report of a 63‐year‐old man who attended the emergency room due to sudden visual loss and best corrected visual acuity (BCVA) of 20/200 in the right eye (RE). Upon his arrival, a visual field was performed in which complete abolition of the right field was observed, severely affecting the central area. A papillary pit was found in the eye fundus. Optical coherence tomography (OCT) revealed a serous retinal detachment (RD) with macular involvement and surgical management was decided.Results: A successful pars plana vitrectomy (PPV) with peeling of the internal limiting membrane and application of an endolaser was performed. Three months later, he came back with a higher serous RD and a worsening of BCVA. We performed a second PPV with sulfur hexafluoride (SF6) with good anatomical results. One year later, cataract and an inferior rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) was treated with intraocular lens implantation and PPV with silicone oil. Five months later, supero‐temporal retina was detached, so a new PPV was carried out with silicone oil again. One year later, the silicone oil was removed and a retinal detachment was noted 3 months later. Finally, the last surgery was performed practicing encircling band, PPV, application of endolaser and again using silicone oil.Conclusions: Surgical management of serous retinal detachment caused by papillary pit continues being a challenge for retinal specialists. Complications of surgery are no usually publish in literature and this case report make us take into account. Since it ranges from observation to surgical approach using different techniques and procedures without any showing clear superiority.

Clinical parameters related to the glial activation and neuronal alterations present in the retinas of COVID‐19 patients

AbstractPurpose: Ocular and eye fundus alterations have been described in COVID‐19 patients. In this study, the aim was to establish several stages of response to damage in the retinal cells from human donors with COVID‐19 and analyse their relationship with clinical parameters.Methods: Retinal sections and flat‐mount retinas from human donors with COVID‐19 (n = 16) and control (n = 12) were analysed with immunohistochemistry. The location of angiotensin‐converting enzyme 2 (ACE2) and the morphology of microglial cells, Müller cells, astrocytes, and photoreceptors were evaluated by confocal microscopy. Microglial analysis and cell death were measured. Clinical data were correlated with different retinal parameters.Results: Müller cells, outer segment of cones and retinal pigment epithelium presented the ACE2 protein. Larger staining of ACE2 and cellular retinaldehyde–binding protein (CRALBP) was found in the cell bodies of Müller cells in COVID‐19 group. Disorganization of honeycomb‐like pattern formed by Müller cells and disruption of external limiting membrane were observed in the 81.3% of COVID‐19 patients. The 53.3% of COVID‐19 patients showed reactive gliosis as well as astrocytes protruding and epiretinal membranes. Cone degeneration was aggravated in the COVID‐19 group. Activated or ameboid‐shape microglia was found in the 93.8% of COVID‐19 patients. Most retinas showed a reduction of the area occupied by microglia and presented microglial nodules around vessels. Retinal degeneration in COVID‐19 group correlated with the duration of the disease (ro: 0.655; p &lt; 0.01) and age (ro: −0.5; p &lt; 0.05). Moreover, microglia activation was correlated with blood oxygen levels (ro: −0.554; p &lt; 0.05).Conclusions: Different stages of glial activation and neuronal alterations are present in COVID‐19 retinas and are significantly correlated with the duration of the disease, age and respiratory failure.