Reduced macular vessel density in COVID-19 patients with and without associated thrombotic events using optical coherence tomography angiography

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 259; no. 8; pp. 2243 - 2249
• Main Authors: Guemes-Villahoz, Noemi, Burgos-Blasco, Barbara, Vidal-Villegas, Beatriz, Donate-López, Juan, de la Muela, María Herrera, López-Guajardo, Lorenzo, Martín-Sánchez, Francisco Javier, García-Feijoó, Julián
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2021; Springer Nature B.V
• Subjects: Adult; Angiography; Case-Control Studies; Coronaviruses; COVID-19; Cross-Sectional Studies; Diagnosis; Female; Fluorescein Angiography; Humans; Infections; Male; Medical imaging; Medicine; Medicine & Public Health; Microvasculature; Middle Aged; Ophthalmology; Patients; Perfusion; Perspectives on COVID-19; Retina; Retinal Disorders; Retinal Vessels - diagnostic imaging; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Tomography; Tomography, Optical Coherence; COVID-19; Retina; SARS-CoV-2; Thrombotic events; OCTA
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-021-05186-0

Purpose
Thrombotic events (TE) represent one of the major complications of SARS-CoV-2 infection. The objective is to evaluate vessel density (VD) and perfusion density (PD) by optical coherence tomography angiography (OCTA) in COVID-19 patients, and compare the findings with healthy controls. The secondary objective is to evaluate if there are differences in OCTA parameters between COVID-19 patients with and without associated TE.
Methods
Cross-sectional case–control study that included patients with laboratory-confirmed diagnosis of COVID-19 with and without TE related to the infection and age-matched healthy controls. Ophthalmological examination and OCTA were performed 12 weeks after diagnosis. Demographic data and medical history were collected. Macular OCTA parameters in the superficial retinal plexus were analyzed according to ETDRS sectors.
Results
Ninety patients were included, 19 (20%) COVID-19 patients with associated TE, 47 (49.5%) COVID-19 patients without TE, and 29 (30.5%) healthy controls. Fifty-three (55.7%) were male, mean age 54.4 (SD 10.2) years. COVID-19 patients presented significantly lower VD than healthy controls: central (
p
 = 0.003), inner ring (
p
 = 0.026), outer ring (
p
 = 0.001). PD was also significantly decreased: outer ring (
p
 = 0.003), full area (
p
 = 0.001). No differences in OCTA parameters were found between COVID-19 patients with and without TE.
Conclusions
OCTA represents a promising tool for the in vivo assessment of microvascular changes in COVID-19. Patients with SARS-CoV-2 infection show lower VD and PD compared to healthy controls. However, no differences were found between COVID-19 when considering TE. Prospective studies are required to further evaluate the retinal microvascular involvement of SARS-CoV-2 and its impact on the vasculature of other organs.