COVID-19 related retinal micro-vasculopathy - a review of current evidence

Abstract

PURPOSE: To evaluate the occurrence of retinal micro-vasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and developed coronavirus disease (COVID-19). DESIGN: Systematic review and meta-analysis. METHODS: The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analysed in RevMan Web versions 3.3. Quality of evidence was assessed using the National institute of health (NIH) quality assessment tool of case-control study. RESULTS: Thirty one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal micro-vasculopathy in subjects with COVID-19 compared to controls. (odds ratio [95% confidence interval], 8.86 [2.54-27.53], p<0.01). Optical coherence tomography angiography (OCTA) reveals reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls. CONCLUSIONS: Our results suggested that COVID-19 related retinal micro-vasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might occurred antecedent to clinically visible changes and could be detected early by OCTA. These findings are significant due to the large numbers with COVID-19 and needs to be recognized by ophthalmologist as a potential long term sequelea of the disease.