Jeniffer Domingues de Jesus¹*, Raquel J Soares¹, Libânia M Dias², Suzana M Ventura¹ and João C Pedro¹

¹Ophthalmology Department, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
²Orthoptics Department, School of Health, Polytechnic of Porto, Porto, Portugal

*Corresponding Author: Jeniffer Domingues de Jesus, Ophthalmology Department, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal.

Received: March 22, 2021; Published: April 30, 2021

Abstract

Purpose: Corona Virus Disease 2019 (COVID-19) is considered a critical global health challenge. Several investigations have suggested vascular dysfunction caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but regarding ophthalmic involvement, only few data are available. Our aim was to evaluate the choroidal involvement in post-COVID-19 patients.

Methods: 40 eyes from 40 patients with previous SARS-CoV-2 infection and 40 eyes from 40 age matched controls were included. Choroidal measurements were made using Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) at 13 different locations: at central fovea and at intervals of 500μm to 1500μm away from the fovea in the temporal, nasal, superior and inferior regions.

Results: Post-COVID-19 patients showed a significant increase in choroidal thickness compared with the control group for all the regions analyzed (all p <0.01). In the Post-COVID-19 group, the choroid is thickest subfoveally and thinnest 1500μm nasal from fovea. In both groups, the superior and temporal macular choroid has been measured thicker than the inferior and nasal macular choroid, respectively.

Conclusion: Our results cautiously suggest that post-COVID-19 patients showed an increase in choroidal thickness compared to control groups. This choroidal thickening may reflect the importance of vascular factors in the pathogenesis of SARS-CoV-2 infection.

Keywords: Choroid; COVID-19; Hemodynamic Changes; Ocular Circulation; Retina; SARS-CoV-2

References

1. Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet (2020).
2. Zhou P., et al. “A pneumonia outbreak associated with a new coronavirus of probable bat origin”. Nature (2020).
3. World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it”. World Heal Organ (2020).
4. Guan W., et al. “Clinical characteristics of coronavirus disease 2019 in China”. The New England Journal of Medicine (2020).
5. Zhu N., et al. “A novel coronavirus from patients with pneumonia in China, 2019”. The New England Journal of Medicine (2020).
6. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard”. World Health Organization (2020).
7. Mao L., et al. “Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China”. JAMA Neurology (2020).
8. Douglas KAA., et al. “Ocular manifestations of COVID-19 (SARS-CoV-2): A critical review of current literature”. In Vivo (2020).
9. Ho D., et al. “COVID-19 and the Ocular Surface: A Review of Transmission and Manifestations”. Ocular Immunology and Inflammation (2020).
10. Qing H., et al. “The possibility of COVID-19 transmission from eye to nose”. Acta Ophthalmologi (2020).
11. Ocansey S., et al. “Ocular Symptoms of SAR-CoV-2: Indication of Possible Ocular Transmission or Viral Shedding”. Ocular Immunology and Inflammation (2020).
12. Dockery DM., et al. “The Ocular Manifestations and Transmission of COVID-19: Recommendations for Prevention”. The Journal of Emergency Medicine (2020).
13. Hooks JJ., et al. “Retina and retinal pigment epithelial cell autoantibodies are produced during murine coronavirus retinopathy”. Journal of Immunology (1993).
14. Seah I and Agrawal R. “Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals”. Ocular Immunology and Inflammation (2020).
15. Marinho PM., et al. “Retinal findings in patients with COVID-19”. Lancet (2020).
16. Savastano A., et al. “Peripapillary Retinal Vascular Involvement in Early Post-COVID-19 Patients”. Journal of Clinical Medicine (2020).
17. Chen J., et al. “A Review of COVID-19 Related Eye Disease (2020).
18. Nickla DL and Wallman J. “The multifunctional choroid”. Progress in Retinal and Eye Research (2010).
19. Maram J., et al. “Evaluating ocular blood flow”. Indian Journal of Ophthalmology (2017).
20. Dalan R and Boehm BO. “The implications of COVID-19 infection on the endothelium: A metabolic vascular perspective”. Diabetes/Metabolism Research and Reviews (2020).
21. Wichmann D., et al. “Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study”. Annals of Internal Medicine (2020).
22. Kaur C., et al. “Blood-retinal barrier in hypoxic ischaemic conditions: Basic concepts, clinical features and management”. Progress in Retinal and Eye Research (2008).
23. Shao L., et al. “Reproducibility of subfoveal choroidal thickness measurements with enhanced depth imaging by spectral-domain optical coherence tomography”. Investigative Ophthalmology and Visual Science (2013).
24. Sýzmaz S., et al. “The effect of smoking on choroidal thickness measured by optical coherence tomography”. British Journal of Ophthalmology (2013).
25. Sim DA., et al. “Repeatability and reproducibility of choroidal vessel layer measurements in diabetic retinopathy using enhanced depth optical coherence tomography”. Investigative Ophthalmology and Visual Science (2013).