Bilateral Central Retinal Artery Occlusion Secondary to SARS-CoV-2 Infection in the Early and Late Periods: A Case ReportBilateraler Verschluss der zentralen Netzhautarterie als Folge von SARS-CoV-2 in der frühen und späten Periode: Fallbericht
The causative agent of coronavirus disease (COVID-19) is a new virus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the coronavirus family. It was first detected in China in December 2019 and spread rapidly around the world. COVID-19 is highly contagious and mainly transmitted through contact with infected patients or droplets. The most common symptoms are fever, cough, weakness, muscle pain, and shortness of breath . SARS-CoV-2 infects host cells through the renin angiotensin-converting enzyme 2 (ACE2) receptors. The ACE2 receptor is widely expressed in many organs, including the retina, and plays a role in the pathogenesis of systemic vascular diseases, which can lead to ocular symptoms such as diabetic and hypertensive retinopathy , . SARS-COV-2 has been reported to be associated with neurological symptoms, including stroke, thromboembolism (e.g., pulmonary embolism), and myocardial infarction. Hypercoagulation associated with COVID-19 has been described as “sepsis-induced coagulopathy” and may predispose patients to the spectrum of thromboembolic events , , .
We present here the first case of bilateral central retinal artery occlusion (CRAO) that developed in the early and late stages secondary to the SARS-CoV-2 infection.
Received: 15 November 2020
Accepted: 05 January 2021
19 February 2021 (online)
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- 1 World Health Organization (WHO). Novel Coronavirus (2019-nCoV) Situation Report-29 (18 February 2020). Geneva, Switzerland: World Health Organization; 2020. Accessed February 3, 2020 at: https://www.who.int/docs/privatNL;default-source/searo/timor-leste/29-04-2020-tls-sitrep-29
- 2 Duan Y, Beli E, Li Calzi S. et al. Loss of Angiotensin-Converting Enzyme 2 Exacerbates Diabetic Retinopathy by Promoting Bone Marrow Dysfunction. Stem Cells 2018; 36: 1430-1440 doi:10.1002/stem.2848
- 3 Verma A, Shan Z, Lei B. et al. ACE2 and Ang-(1–7) confer protection against development of diabetic retinopathy. Mol Ther 2012; 20: 28-36 doi:10.1038/mt.2011.155
- 4 Zhang Y, Xiao M, Zhang S. et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med 2020; 382: e38 doi:10.1056/NEJMc2007575
- 5 Bavishi C, Bonow RO, Trivedi V. et al. Acute myocardial injury in patients hospitalized with COVID-19 infection: A review. Prog Cardiovasc Dis 2020; DOI: 10.1016/j.pcad.2020.05.013.
- 6 Grillet F, Behr J, Calame P. et al. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected with Pulmonary CT Angiography. Radiology 2020; 296: E186-E188 doi:10.1148/radiol.2020201544
- 7 Oxley TJ, Mocco J, Majidi S. et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med 2020; 382: e60 doi:10.1056/NEJMc2009787
- 8 Varma DD, Cugati S, Lee AW. et al. A review of central retinal artery occlusion: clinical presentation and management. Eye (Lond) 2013; 27: 688-697 doi:10.1038/eye.2013.25
- 9 Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusions in young adults. Am J Ophthalmol 1995; 120: 776-783 doi:10.1016/S0002-9394(14)72731-X
- 10 Acharya S, Diamond M, Anwar S. et al. Unique case of central retinal artery occlusion secondary to COVID-19 disease. IDCases 2020; 21: e00867 doi:10.1016/j.idcr.2020.e00867
- 11 Dinkin M, Gao V, Kahan J. et al. COVID-19 presenting with ophthalmoparesis from cranial nerve palsy. Neurology 2020; 95: 221-223 doi:10.1212/WNL.0000000000009700
- 12 Lantos JE, Strauss SB, Lin E. COVID-19-Associated Miller Fisher Syndrome: MRI Findings. AJNR Am J Neuroradiol 2020; 41: 1184-1186 doi:10.3174/AJNR.A6609
- 13 Douglas KAA, Douglas VP, Moschos MM. Ocular Manifestations of COVID-19 (SARS-CoV-2): A Critical Review of Current Literature. In Vivo 2020; 34: 1619-1628 doi:10.21873/invivo.11952
- 14 Panigada M, Bottino N, Tagliabue P. et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost 2020; 18: 1738-1742 doi:10.1111/jth.14850
- 15 Rotzinger DC, Beigelman-Aubry C, von Garnier C. et al. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thromb Res 2020; 190: 58-59 doi:10.1016/j.thromres.2020.04.011
- 16 Lodigiani C, Iapichino G, Carenzo L. et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020; 191: 9-14 doi:10.1016/j.thromres.2020.04.024
- 17 Beyrouti R, Adams ME, Benjamin L. et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020; 91: 889-891 doi:10.1136/jnnp-2020-323586
- 18 Tan YK, Goh C, Leow AST. et al. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis 2020; 50: 587-595 doi:10.1007/s11239-020-02228-y
- 19 Sheth J, Narayanan R, Goyal J. et al. Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol 2020; 68: 2291 doi:10.4103/ijo.IJO_2380_20
- 20 Tang N, Bai H, Chen X. et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18: 1094-1099 doi:10.1111/jth.14817
- 21 Klein DE, Libman R, Kirsch C. et al. Cerebral venous thrombosis: A typical presentation of COVID-19 in the young. J Stroke Cerebrovasc Dis 2020; 29: 104989 doi:10.1016/j.jstrokecerebrovasdis.2020.104989
- 22 Klok FA, Kruip MJHA, van der Meer NJM. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145-147
- 23 Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020; 18: 1559-1561