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   Table of Contents      
LETTER TO THE EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 194-195

Comments on: Retinal vein occlusion in COVID-19: A novel entity


1 Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
2 GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
3 Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Padmamalini Mahendradas
Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3279_20

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How to cite this article:
Mahendradas P, Sethu S, Sanjay S, Kawali A, Shetty R. Comments on: Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol 2021;69:194-5

How to cite this URL:
Mahendradas P, Sethu S, Sanjay S, Kawali A, Shetty R. Comments on: Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol [serial online] 2021 [cited 2021 Jan 21];69:194-5. Available from: https://www.ijo.in/text.asp?2021/69/1/194/303333



Dear Editor,

We congratulate Sheth et al. for their article certainly did describe a very unique entity of retinal vein occlusion (RVO) secondary to Coronavirus disease (COVID-19).[1] The report shares clinically relevant information and strategy that would be necessary to follow in the differential diagnosis of ocular conditions, particularly in patients with recent history of COVID-19. Authors have made a presumptive diagnosis as vasculitic-RVO secondary to COVID-19 based on the ocular clinical presentation and the currently known pathobiology of COVID-19. The authors have performed a detailed systemic workup for vasculitic and non-vasculitic causes of RVO and state that the tests did not reveal any remarkable factors. Given the very recent history of COVID-19 in the patient, additional investigations such as serum D-dimer, serum ferritin, lactate dehydrogenase (LDH), serum troponin and interleukin-6[2],[3] would have been helpful to know the systemic coagulability and/or inflammatory status secondary to COVID-19 and its relationship with vasculitic-RVO. Since the patient was affected by a mild form ahead of COVID-19 based on the time to discharge history (in 1 week) and with unremarkable hematological findings (CRP, ESR, etc.), it is unlikely that the patient might have “experienced” a cytokine storm. Hence, vasculitic-RVO may not have been secondary to a cytokine storm, but yet would have been secondary to COVID-19.

It would be beneficial to know the rationale behind the use of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection of ranibizumab biosimilar, Razumab® (Intas Pharmaceuticals, Ahmedabad, India; 0.5 mg/0.05 mL) for this patient, in addition to systemic steroid therapy. Systemic steroid therapy alone might have controlled the eye inflammation and macular edema in this case. Further management, including the use of intravitreal anti-VEGF could have been based on response to systemic steroid therapy.

This report indicates the possibility of COVID-19 associated ocular presentations of vascular occlusion. Hence, it would be highly relevant to expand the systemic workup parameters to include COVID-19 pathobiology associated factors as discussed earlier for a more definitive differential diagnosis and to unravel the mechanism underlying the pathogenesis of COVID-19 associated ocular disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sheth JU, Narayanan R, Goyal J, Goyal V. Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol 2020;68:2291-3.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, et al.; California MIS-C Response Team. COVID-19–associated multisystem inflammatory syndrome in children—United States, March–July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1074-80.  Back to cited text no. 2
    
3.
Morris SB, Schwartz NG, Patel P, Abbo L, Beauchamps L, Balan S, et al. Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection - United Kingdom and United States, March-August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1450-6.  Back to cited text no. 3
    




 

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