COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease?

Importance COVID-19 is caused by SARS-CoV-2, a betacoronavirus that uses the angiotensin-converting enzyme-related carboxypeptidase (ACE2) receptor to gain entry into cells. ACE2 receptor is widely expressed in multiple organs, including the retina, an extension of the central nervous system. The ACE2 receptor is involved in the diabetic and hypertensive retinopathy. Additionally, coronaviruses cause ocular infections in animals, including retinitis, and optic neuritis. Objective To assess whether there is any retinal disease associated with COVID-19. Design We have evaluated 27 asymptomatic subjects, with retinal fundoscopic, optical coherence tomography (OCT) and OCT angiography fourteen days after hospital discharge due to COVID-19 bilateral pneumonia. Results Cotton wool exudates were evident in six out of 27 patients evaluated, a 22%. Cotton wool exudates are a marker vascular disease severity in other medical context, that is diabetes and hypertension, and are associated with increased risk for acute vascular events. Whether antiaggregation therapy may play a role on fundoscopic-selected patients with COVID-19 requires prospective trials.

Automated summary

COVID-19 is caused by SARS-CoV-2, which utilizes the ACE2 receptor to gain entry into cells. This study evaluated retinal abnormalities in asymptomatic COVID-19 patients, finding that cotton wool exudates were present in 22% of cases, indicating potential vascular disease severity. Prospective trials are needed to determine the role of antiaggregation therapy in these patients.