A vision-threatening retinal condition associated with COVID-19

According to Southern California ophthalmologists, COVID-19 infection can boost the number of rare eye conditions that threaten vision when a vein in the retina is occluded.

The risk of retinal vein occlusion was higher 6 months after infection than 6 months ago (adjusted incidence ratio) [IRR] 1.54, 95% CI 1.05-2.26, P= 0.03), according to Kaiser Permanente Southern California Vitreous Retina Surgeon Bobeck Modjtahedi, MD, and colleagues in Baldwin Park, California.

The number of reported cases is still very small, 8.3 cases per 1 million patients 6 months before infection and 12.2 cases per 1 million patients 6 months after infection, and the link to COVID-19 is not clear. is not.Attention JAMA Ophthalmology..

However, “these results are compelling and consistent with the general trends seen in COVID-19 and systemic vascular disease,” Modjtahedi said. Today’s Med Page. “Retinal vein occlusion is a rare event after COVID-19 infection, but these events can cause irreversible loss of vision.”

Researchers Linked a long list of neuro-eye / retinal conditions to COVID-19Photophobia, retinal hemorrhage, optic neuritis, etc.

For a new study, Modjtahedi’s group retrospectively followed and infected 432,515 patients in the Kaiser Permanente Southern California medical system who were positive for COVID-19 from January 2020 to May 2021. We investigated changes in the incidence of later retinal artery and venous occlusions.

According to Modjtahedi, occlusion of arteries and veins in the retina occurs when the obstruction impedes blood flow inside and outside the eye.

“Although there are treatments for secondary related events such as macular edema, patients can suffer from vision loss, which is often permanent,” he said. “These conditions are common in patients with systemic vascular disease such as diabetes and high blood pressure.”

For retinal artery occlusion, the group showed no significant difference in the incidence before (2.3 per million) or after (3.0 per million) COVID-19 infection (adjusted IRR 1.35, 95). % CI 0.64-2.85).

Regarding the potential cause between infection and retinal vein occlusion, Modjtahedi pointed out that COVID-19 may induce coagulation.

“The associations we have observed may come from secondary events that are not directly related to the virus, such as worsening blood pressure or lack of physical activity after infection,” he added. .. “This should be taken into account as the peak incidence of retinal vein occlusion after COVID-19 was 6-8 weeks after infection. Patients with delayed diagnosis or prolonged thrombosis promotion for several weeks. Is a condition due to a secondary event. “

The study “further strengthens the link between COVID-19 and retinal ischemic syndrome,” wrote K. Thiran Jayasundera, MD, MS, and colleagues at the University of Michigan, Ann Arbor. Accompanying commentary.. “But this strength and consistency of relevance provides a solid foundation for causality and access to other large databases currently available to help determine recommended strategies for prevention and monitoring. It will be enhanced by further evaluation, including research. “

Jayasundera’s group also said, “Severe COVID-19 infections are expected to cause more vascular occlusion, which could be counteracted by anticoagulant therapy initiated in inpatients with severe COVID-19. There is. “

Overall, the study found 12 cases of retinal artery occlusion and 43 cases of retinal vein occlusion 6 months before COVID-19 infection. Six months after infection, these numbers were 16 and 65, respectively.

The average age of patients in this study was 41 years, with 53.6% female, 60.7% Hispanic, and 20.3% Caucasian. As for comorbidity, 15.3% had a history of diabetes, 24.3% had hypertension, 20.6% were overweight, and 31.9% were obese. Most patients (93.7%) did not require hospitalization due to COVID-19 infection.

Hospitalization with COVID was associated with an increased risk of retinal vein occlusion only in an unadjusted analysis. The main analysis adjustments were made for various confounding factors such as race, obesity index, diabetes, and other factors.