Different Cases, Different Manifestations of Post-COVID-19 Retinal Artery Occlusion: A Case Series

Coronavirus disease 2019 (COVID-19) is a procoagulant disease that increases the risk of clinically evident thrombotic complications. Herein we present 3 cases with different retinal artery occlusions that emerged soon after the diagnosis of COVID-19. The first patient had central retinal artery occlusion (CRAO) that resulted in visual loss in one eye. The second patient had inflammatory peripheral retinal artery occlusion, vasculitis, and uveitis which did not affect vision. The third patient presented with CRAO following the progression from orbital cellulitis to orbital apex syndrome. Interestingly, CRAO progressed to internal carotid artery occlusion in this case within days and resulted in monocular visual loss. Variations in the underlying pathophysiology and the characteristics of individual immune responses in patients with COVID-19 may be factors that determine differences in clinical manifestations. This article aims to describe different presentations of COVID-19-related retinal artery occlusions and discuss possible pathophysiological aspects.

[1]  Md. Mujibur Rahman,et al.  Acute Ischemic Stroke With Central Retinal Artery Occlusion as a Rare Presentation of COVID-19 Disease , 2021, Cureus.

[2]  Servet Cetinkaya,et al.  Central retinal artery occlusion in a patient who contracted COVID-19 and review of similar cases , 2021, BMJ Case Reports.

[3]  H. Ozdemir,et al.  Cilioretinal artery occlusion with paracentral acute middle maculopathy associated with COVID-19 , 2021, Indian journal of ophthalmology.

[4]  M. Bagheri,et al.  Orbital apex syndrome in COVID-19 patient, a case report , 2021, Visual Journal of Emergency Medicine.

[5]  D. Morrow,et al.  Diagnosis, Management, and Pathophysiology of Arterial and Venous Thrombosis in COVID-19. , 2020, JAMA.

[6]  G. Staurenghi,et al.  Impending Central Retinal Vein Occlusion in a Patient with Coronavirus Disease 2019 (COVID-19) , 2020, Ocular immunology and inflammation.

[7]  E. Carreño,et al.  Panuveitis and Optic Neuritis as a Possible Initial Presentation of the Novel Coronavirus Disease 2019 (COVID-19) , 2020, Ocular immunology and inflammation.

[8]  J. Wille,et al.  Arterial thrombotic complications in COVID-19 patients , 2020, Journal of Vascular Surgery Cases and Innovative Techniques.

[9]  Karlheinz Peter,et al.  The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications , 2020, Circulation research.

[10]  S. Pittaluga,et al.  Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series , 2020, EClinicalMedicine.

[11]  Y. Kanthi,et al.  COVID–19-associated coagulopathy: An exploration of mechanisms , 2020, Vascular medicine.

[12]  G. Manousakis,et al.  Neurological involvement of coronavirus disease 2019: a systematic review , 2020, Journal of Neurology.

[13]  J. Alió,et al.  COVID-19 Disease and Ophthalmology: An Update , 2020, Ophthalmology and Therapy.

[14]  J. Bartholomew,et al.  Coagulopathy in COVID-19. , 2020, Cleveland Clinic journal of medicine.

[15]  T. Hussain Faculty Opinions recommendation of Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2. , 2020 .

[16]  J. Thachil,et al.  Coagulation abnormalities and thrombosis in patients with COVID-19 , 2020, The Lancet Haematology.

[17]  M. Tay,et al.  The trinity of COVID-19: immunity, inflammation and intervention , 2020, Nature Reviews Immunology.

[18]  J. Marini,et al.  Management of COVID-19 Respiratory Distress. , 2020, JAMA.

[19]  D. Gommers,et al.  Incidence of thrombotic complications in critically ill ICU patients with COVID-19 , 2020, Thrombosis Research.

[20]  L. Mao,et al.  Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. , 2020, JAMA neurology.

[21]  Feng Wang,et al.  Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia , 2020, Journal of Thrombosis and Haemostasis.

[22]  Weidong Wu,et al.  Virology, Epidemiology, Pathogenesis, and Control of COVID-19 , 2020, Viruses.

[23]  Andrew P. Vreede,et al.  Adenosine receptor agonism protects against NETosis and thrombosis in antiphospholipid syndrome , 2019, Nature Communications.

[24]  Jae C. Chang Acute Respiratory Distress Syndrome as an Organ Phenotype of Vascular Microthrombotic Disease: Based on Hemostatic Theory and Endothelial Molecular Pathogenesis , 2019, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[25]  B. Mallavia,et al.  Maladaptive role of neutrophil extracellular traps in pathogen-induced lung injury. , 2018, JCI insight.

[26]  T. van der Poll,et al.  The coagulation system and its function in early immune defense , 2014, Thrombosis and Haemostasis.

[27]  D. Varma,et al.  Treatment Options for Central Retinal Artery Occlusion , 2012, Current Treatment Options in Neurology.

[28]  S. Visovatti,et al.  Ectonucleotidase tri(di)phosphohydrolase-1 (ENTPD-1) disrupts inflammasome/interleukin 1β-driven venous thrombosis. , 2019, The Journal of clinical investigation.