The observed association of COVID-19 infection and coagulation dysfunction may also affect the eyes, according to examinations of patients with hemi- or central retinal vein occlusion (HRVO or CRVO) who don’t otherwise have underlying risk factors and to the observed timeline of ocular symptoms arising within weeks after COVID-19 infection.
Study design
This multicenter, retrospective, nonconsecutive case series reported cases of HRVO or CRVO in patients under the age of 50 years, with no underlying coagulopathy, and with confirmed COVID-19 infection. Patients with risk factors for vascular events, such as hypertension, diabetes, glaucoma, obesity, and hypercoagulable states, were excluded.
Outcomes
Twelve eyes of 12 patients were included, with 9 cases of CRVO and 3 cases of HRVO. The median age was 32 years old. Macular edema was noted in 42% of the eyes, of which 80% (4 of 5) were treated with intravitreal anti-VEGF injections. The vast majority of eyes (11 of 12) had partial or complete resolution of ocular findings at final follow-up. The final VA ranged from 20/20 to 20/60, with 11 of the 12 (92%) eyes achieving a VA of ≥20/40 at final follow-up.
Limitations
A direct causal relationship between COVID-19 infection and RVO cannot be established in this small case series.
Clinical significance
As coagulation dysfunction has been reported in multiple organ systems with COVID-19 infection, additional surveillance and consideration of COVID-19 infection on the differential diagnosis of RVO in younger patients may be warranted. Thankfully, the majority of the young patients described in this series achieved good vision with resolution of ocular findings at final follow-up. Information from larger series, and comparison of RVO outcomes in young patients with and without COVID-19 infection, would be of interest.