Case of Retinal Vein Occlusion Due to COVID-19 Reported in IJO

Systemic workup for vasculitic and non-vasculitic causes of retinal vein occlusion was done. Evaluation of blood pressure, complete blood count, erythrocyte sedimentation rate, serum lipid profile, sugar levels, plasma protein electrophoresis, C-reactive protein, serum homocysteine level, serum angiotensin-converting enzyme (ACE), tuberculin skin testing, QuantiFERON-TB Gold and thrombophilia-screening showed no significant abnormality.

A presumptive diagnosis of vasculitic retinal vein occlusion secondary to COVID-19 was made due to PCR positivity to the same and absence of any other associated cause. Systemic vasculitis due to COVID-19 secondary to Type 3 hypersensitivity reaction and triggering of cytokine storm by the deposition of immune complexes has been extensively reported. According to the authors, the retinal vasculitis in this patient could be a part of this spectrum of systemic immune mediated vasculitis. Similar occlusive retinal vasculitis has been reported with other viral infections like dengue and chikungunya

Based on this presumptive diagnosis, the patient was treated with oral methylprednisolone and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. Recent studies recommend treatment with steroids and anti-coagulants like heparin to prevent thromboembolic complications associated with systemic vasculitis in COVID-19. Oral steroids were started in accordance to the same. At the end of a month, the best corrected visual acuity in the left eye improved to 6/9 with complete resolution of the serous detachment and edema at the macula.

Ocular manifestations in COVID-19 are uncommon with conjunctivitis being reported as the most common presentation. A few reports of intraretinal haemorrhages and cotton wool spots are also present in literature.

"Knowledge of this new entity will help us remain vigilant about similar vision-threatening complications while dealing with patients of COVID-19", conclude the authors.

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