Indian Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 69  |  Issue : 1  |  Page : 192-

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


P Raja Rami Reddy1, Deependra V Singh2, Abhilasha Baharani3,  
1 Retina Services, Neoretina Eyecare Institute, Chapel Road, Nampally, Hyderabad, Telangana, India
2 Retina Services, EyeQ Super Speciality Eye Hospital, DLF Gurugram, Haryana, India
3 Uvea Services, Neoretina Eyecare Institute, Chapel Road, Nampally, Hyderabad, Telangana, India

Correspondence Address:
Dr. P Raja Rami Reddy
Retina Services, Neoretina Eyecare Institute, Chapel Road, Nampally, Hyderabad, Telangana
India




How to cite this article:
Reddy P R, Singh DV, Baharani A. Comments on: Retinal vein occlusion in COVID-19: A novel entity.Indian J Ophthalmol 2021;69:192-192


How to cite this URL:
Reddy P R, Singh DV, Baharani A. Comments on: Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol [serial online] 2021 [cited 2021 Feb 27 ];69:192-192
Available from: https://www.ijo.in/text.asp?2021/69/1/192/303331


Full Text



Dear Editor,

We read with interest the case report by Sheth JU et al., where they have attributed a retinal vein occlusion (RVO) in a 52-year-old male to COVID-19 infection.[1] We congratulate the authors for the successful management of the case, however, we would like to present the following arguments against considering it a “vasculitic-RVO” or a manifestation of COVID-19.

The fundus photograph of the case showed retinal tortuosity, cotton-wool spots, and hemorrhages limited to quadrants drained by the affected veins. Perivascular exudates, cuffing, or sheathing that are typically seen in retinal vasculitis, were missing. Fluorescein angiography (FA) showed vascular staining and posterior pole leak, which is commonly seen in RVO.[2] However, there was no visible discontinuity or segmentation of vessel wall staining and leakage. Hence, the fundus and FA findings were not suggestive of a retinal vasculitis. The SUN Working group, in their first international workshop, did warn about confusing occlusive retinal vasculopathy with vasculitis.

We understand that standardized disease-defining guidelines for COVID-19 are still awaited, but COVID-19-related vasculopathy in various organs including retina, have already been described. Most cases have elevated levels of D-dimer, fibrinogen and von Willebrand factor.[3],[4],[5] Toshiaki et al. have reviewed the literature on COVID-19-associated coagulopathy and found that patients can have normal prothrombin and activated partial thromboplastin times, and platelet count. In his editorial, Becker RC has also recommended distinguishing COVID-19-associated vasculopathy from vasculitis.[5]

Therefore, in the absence of any signs of systemic or retinal vasculitis, or details of the patient's one week course during hospital admission and unavailability of relevant systemic biomarkers of COVID-19 coagulopathy, the case cannot be considered representative of COVID-19-related retinal findings based solely on a temporal association.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Sheth JU, Narayanan R, Goyal J, Goyal V. Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol 2020;68:2291-3.
2Hayreh SS, Zimmerman MB. Fundus changes in branch retinal vein occlusion. Retina (Philadelphia, Pa.) 2015;35:1016-27.
3Acharya S, Diamond M, Anwar S, Glaser A, Tyagi P. Unique case of central retinal artery occlusion secondary to COVID-19 disease. IDCases 2020;21:e00867.
4Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res 2020:1-9. doi: 10.1007/s00011-020-01401-6.
5Becker RC. COVID-19-associated vasculitis and vasculopathy. J Thromb Thrombolysis 2020;50:499-511.