Front Pharmacol 11:588384.
Case Report: Central Retinal Artery Occlusion in a COVID-19 Patient
Affiliations
- 1Department of Ophthalmology, Fondation Asile des Aveugles, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
- 2Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy.
Abstract
We report a case of central retinal artery occlusion (CRAO) in a patient with a previous history of severe COVID-19 disease. This disease has been associated with inflammatory-induced homeostasis changes leading to endothelial dysfunction and a procoagulant state with multi-organ involvement, but the burden of thromboembolic complications in COVID-19 patients is currently unknown. The pathogenesis of retinal artery occlusions is a multifactorial process where inflammation and hypercoagulation state are established risk factors. Even if our experience may represent a coincidental relationship, it is likely that COVID-19 patients could be at risk of developing retinal vascular occlusions. A focused ophthalmological surveillance is advisable to prevent and manage this possible cause of severe vision loss that has an important impact in health care system.
Keywords: SARS-CoV-2; case report; central retinal artery occlusion; coronavirus disease-2019; severe acute respiratory syndrome coronavirus 2; thrombosis.
Copyright © 2020 Montesel, Bucolo, Mouvet, Moret and Eandi.
Discussion
The COVID-19 disease has been described to induce inflammatory-induced homeostasis changes that predispose to thrombotic disease in both venous and arterial circulation (
Levi et al., 2020;
Levolger et al., 2020). Post-mortem analysis showed evidence of direct viral infection of the endothelial cells and diffuse endothelial inflammation leading to endothelial dysfunction and a procoagulant state (
Varga et al., 2020). The risk of thromboembolic events in COVID-19 patients is currently under investigation, with preliminary results showing significantly prolonged prothrombin time, high D-dimer levels and increased concentrations of proinflammatory cytokines and biomarkers of inflammation in patients with more severe disease, indicating the likelihood of disseminated intravascular coagulation or thrombotic microangiopathy (
Connors and Levy, 2020;
Levi et al., 2020). Even though most cases are affected by venous thromboembolism (
Llitjos et al., 2020), there are increasing reports of COVID-19 induced arterial thromboembolic complications, highlighting the thrombogenicity of SARS-CoV-2 infection (
Levolger et al., 2020).
Lodigiani et al. (2020) in a cohort of 388 consecutive patients with laboratory-proven COVID-19 requiring hospital admission, disclosed a remarkable rate of venous and arterial thromboembolic complications of approximately 8% despite the use of anticoagulant prophylaxis (
Lodigiani et al., 2020).
It is also well established that a considerable percentage of subjects infected by the coronavirus develop a mild infection or are asymptomatic, and in these cases the clinical and histopathology data available are limited. Hence, the burden of thromboembolic complications in COVID-19 patients is currently unknown, with some authors suggesting that it may represent an underestimated, large-scale issue (
Lodigiani et al., 2020)…
