Choroidal, Retinal Changes May Follow COVID-19 With Pulmonary Involvement

Patients with COVID-19 who have pulmonary involvement may experience significant retinal and choroidal thickness changes compared with individuals with COVID-19 who were asymptomatic with no pulmonary involvement, according to a study published in Photodiagnosis and Photodynamic Therapy. These findings may reveal a predisposition to future ischemic retinal and optic nerve diseases among patients with pulmonary involvement, the report suggests.

Researchers included individuals with COVID-19 who were asymptomatic (n=118; 60 women; mean age, 42.88 years) and  patients with COVID-19 who had pulmonary involvement (n=50; 27 women; mean age, 41.90 years) in the prospective, case-control study. All participants underwent comprehensive ophthalmic examinations and choroidal, macular, ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) after testing negative for COVID-19.

Patients with pulmonary involvement had significantly thinner mean inner temporal superior (105.08 vs 108.45 μm; P =.006), inner nasal superior (111.86 vs 116.66 μm; P =.001), inner nasal inferior (111.00 vs 115.05 μm; P =.001), inner temporal inferior (99.80 vs 107.31 μm; P =0.000), outer temporal superior (85.60 vs 88.81 μm; P =.036), outer temporal inferior (88.18 vs 90.99 μm; P =.022), and outer nasal superior (103.92 vs 109.32 μm; P =.003) GCC thicknesses compared with participants who were asymptomatic. Mean GCC (101.26 vs 105.46 μm; P =.003) inferior and mean RNFL (114.22 vs 119.27 μm; P =.021 and 102.40 vs 106.33 μm; P =.029, respectively), and subfoveal choroidal thickness measurements (281.96 vs 291.19 μm; P =.036) were also significantly thinner among individuals with pulmonary involvement compared with participants with no pulmonary involvement.

Conversely, COVID-19 with pulmonary involvement was associated with thicker inner inferior (309.56 vs 304.36 μm; P =.020) and outer superior (276.65 vs 270.65 μm; P =.040) macular thicknesses compared with asymptomatic COVID-19.

“Subclinical choroid, retina, and optic nerve involvement may be present in COVID-19 patients with pulmonary involvement receiving supplemental oxygen [. . .],” according to the researchers. “COVID-19 patients with a history of pulmonary involvement and hypoxia should be considered in retinal and neuro-ophthalmological clinics, and it may be necessary to consider them in the differential diagnosis of ischemia-based pathologies.”

Potential confounding due to COVID-19 treatment and a small sample size are acknowledged limitations to the research.