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Retinal microvascular signs in COVID-19
  1. Ralene Sim1,2,
  2. Gemmy Cheung1,2,
  3. Daniel Ting1,2,
  4. Edmund Wong1,2,
  5. Tien Yin Wong1,2,
  6. Ian Yeo1,2,
  7. Chee Wai Wong1,2
  1. 1 Singapore National Eye Centre, Singapore
  2. 2 Singapore Eye Research Institute, Singapore
  1. Correspondence to Dr Ian Yeo, Singapore National Eye Centre, Singapore, Singapore; ian.yeo.y.s{at}singhealth.com.sg

Abstract

Background/aims To explore if retinal findings are associated with COVID-19 infection.

Methods In this prospective cross-sectional study, we recruited participants positive for COVID-19 by nasopharyngeal swab, with no medical history. Subjects underwent retinal imaging with an automated imaging device (3D OCT-1 Maestro, Topcon, Tokyo, Japan) to obtain colour fundus photographs (CFP) and optical coherence tomographic (OCT) scans of the macula. Data on personal biodata, medical history and vital signs were collected from electronic medical records.

Results 108 patients were recruited. Mean age was 36.0±5.4 years. 41 (38.0%) had symptoms of acute respiratory infection (ARI) at presentation. Of 216 eyes, 25 (11.6%) had retinal signs—eight (3.7%) with microhaemorrhages, six (2.8%) with retinal vascular tortuosity and two (0.93%) with cotton wool spots (CWS). 11 eyes (5.1%) had hyper-reflective plaques in the ganglion cell-inner plexiform layer layer on OCT, of which two also had retinal signs visible on CFP (CWS and microhaemorrhage, respectively). There was no significant difference in the prevalence of retinal signs in symptomatic versus asymptomatic patients (12 (15.0%) vs 13 (9.6%), p=0.227). Patients with retinal signs were significantly more likely to have transiently elevated blood pressure than those without (p=0.03).

Conclusion One in nine had retinal microvascular signs on ocular imaging. These signs were observed even in asymptomatic patients with normal vital signs. These retinal microvascular signs may be related to underlying cardiovascular and thrombotic alternations associated with COVID-19 infection.

  • retina
  • infection
  • imaging
  • epidemiology

Data availability statement

Data are available upon reasonable request. Deidentified participant data will be available upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Deidentified participant data will be available upon reasonable request.

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Footnotes

  • Contributors CWW was involved in literature review, protocol development, gaining ethical approval and conceiving the study. IYSY, CWW and RS were involved in patient recruitment, data collection and data analysis. CWW and RS wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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