COVID-19 infection linked to Increased Retinal Vascular Occlusions: JAMA

New findings published in the Journal of American Medical Association affirm that there was an increasing incidence of retinal vein occlusions (RVOs) following COVID-19 infection; however, these occurrences are still rare, and a cause-and-effect link cannot be proved in the absence of randomized controlled trials.

COVID-19 has been linked to systemic vascular injury; however, the danger to the retinal vasculature is yet unknown. As a result, Bobeck S. Modjtahedi and colleagues undertook this investigation to see if the prevalence of retinal vascular occlusions changed following COVID-19 infection.

Participants without a background of retinal vascular occlusion who were confirmed with COVID-19 infection between January 20, 2020, and May 31, 2021 were enrolled in this cohort research at an integrated health care organization (Kaiser Permanente Southern California). Participants were excluded if they had a background of retinal artery occlusions (RAOs) or retinal vein occlusions (RVOs) more than 6 months before to their COVID-19 diagnosis, or if they had been enrolled in Kaiser Permanente Southern California for less than 6 months prior to their COVID-19 diagnosis. all the participants with COVID-19 were included for this study. The primary finding of this study was a decrease in the average biweekly incidence of new RAOs and RVOs following a COVID-19 diagnosis.

The key findings of this study were as follow:

1. This study includes 432 515 individuals who have been diagnosed with COVID-19 infection.

2. The mean (SD) age was 40.9 (19.2) years, and 231 767 (53.6%) of the patients were female.

3. In the six months following COVID-19 diagnosis, sixteen individuals had a RAO and 65 had an RVO.

4. After controlling for age, gender, self-reported race and ethnicity, body mass index, history of diabetes, hypertension, or hyperlipidemia, and hospitalization, the incidence of new RVOs was greater 6 months after COVID-19 infection compared to 6 months before infection.

5. There was a modest rise in RAOs following a COVID-19 diagnosis.

6. RAOs and RVOs were most common 10 to 12 weeks and 6 to 8 weeks following COVID-19 diagnosis, respectively.

In conclusion, when evaluating patients following infection, clinicians must evaluate the probable link between COVID-19 infection and retinal vascular occlusions. The findings add to the evidence of COVID-19-induced prothrombosis and suggest that the effects of the infection may linger for several weeks. Large epidemiologic investigations are needed to further establish the link between COVID-19 infection and retinal thromboembolic events.

Reference:

Modjtahedi BS, Do D, Luong TQ, Shaw J. Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis. JAMA Ophthalmol. Published online April 14, 2022. doi:10.1001/jamaophthalmol.2022.0632