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The neurovascular retinal involvement in a large population of patients recovered from COVID-19: an OCT and OCT angiography study

Eye (2024)Cite this article

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Abstract

Background

This study aimed to assess the neuronal and microvascular retinal and choroidal involvement in COVID-19 recovered patients using optical coherence tomography (OCT) and OCT angiography (OCTA).

Methods

This observational cross-sectional study recruited patients recovered from COVID-19 and a group of healthy controls for comparisons. OCT (peripapillary scan and macular map) and OCTA (macular map) were performed to obtain: the central subfield thickness (CST), the macular volume (MV), the peripapillary retinal nerve fibre layer (pRNFL) thickness, the vessel area density (VAD), vessel length fraction (VLF), vessel diameter index (VDI) and fractal dimension (FD) of the superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP), and the vessel density (VD), stromal density (SD) and vascular/stromal (V/S) ratio of the choriocapillaris (CC) and choroid (Ch). Data regarding disease severity, administered therapy and prior comorbidities were collected.

Results

We recruited 676 eyes from 338 patients and 98 eyes from 49 healthy controls. VAD of all the three retinal plexuses, VLF and VDI of ICP and DCP and VD of CC were significantly reduced in patients versus controls. No differences were found in CST, MV and pRNFL. A multivariate analysis showed that oxygen therapy, previous cardio/cerebrovascular events and hypertension negatively influenced vascular parameters.

Conclusion

A microvascular retinal and choriocapillaris damage may be identified secondary to SARS-CoV-2 infection, even after recovery. OCTA may represent a reproducible and non-invasive tool to assess microangiopathy in these patients, with particular regard to those with previous cardio/cerebrovascular events, hypertension and those who received oxygen therapy.

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Data availability

The data presented in this study are available in the article. Eventual additional data are available on request from the corresponding author.

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Acknowledgements

The research contribution by the G.B. Bietti Foundation was supported by Fondazione Roma and Ministry of Health. The authors thank Fabiano Cavarzeran, Department of Ophthalmology, University of Padova, for the statistical elaboration of the data.

Author information

Authors and Affiliations

  1. Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy

    Eleonora Cosmo, Luisa Frizziero, Stefano Schiavon, Tommaso Torresin, Edoardo Armato Smaniotto Dai Roveri, Raffaele Parrozzani & Edoardo Midena

  2. Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128, Padova, Italy

    Anna Maria Cattelan & Davide Leoni

  3. Department of Directional Hospital Management, University of Padova, 35128, Padova, Italy

    Alfio Capizzi

  4. IRCCS—Fondazione Bietti, 00198, Rome, Italy

    Giulia Midena & Edoardo Midena

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  1. Eleonora Cosmo
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Contributions

EM, LF, EC, RP: study conception, design, interpretation of data, drafting and revising, final approval and agreement to be accountable for all aspects of the work. SS, AC, DL, AC, TT, GM, EA: data acquisition/analysis/interpretation, drafting and revising of work, final approval and agreement to be accountable for all aspects of the work. All authors read and approved the final manuscript.

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Correspondence to Edoardo Midena.

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Cosmo, E., Frizziero, L., Schiavon, S. et al. The neurovascular retinal involvement in a large population of patients recovered from COVID-19: an OCT and OCT angiography study. Eye (2024). https://doi.org/10.1038/s41433-024-02991-9

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