COVID-19-Related Retinal Micro-vasculopathy - A Review of Current Evidence

Am J Ophthalmol. 2022 Mar:235:98-110. doi: 10.1016/j.ajo.2021.09.019. Epub 2021 Sep 26.


Purpose: To evaluate the occurrence of retinal microvasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who 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 analyzed in RevMan Web versions 3.3. Quality of evidence was assessed using the National Institute of Health quality assessment tool for a 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 microvasculopathy in subjects with COVID-19 compared to controls (odds ratio [95% confidence interval], 8.86 [2.54-27.53], P < .01). Optical coherence tomography angiography (OCTA) revealed reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls.

Conclusions: The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might have occurred antecedent to clinically visible changes and could be detected earlier by OCTA. These findings are significant, due to the large numbers with COVID-19, and need to be recognized by ophthalmologists as a potential long-term sequalae of the disease.

Keywords: COVID-19; FAZ; OCTA; SARS-CoV-2; cotton wool spots; retina haemorrhage; retina microvasculopathy; retinopathy; review; vessel density.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • COVID-19*
  • Case-Control Studies
  • Fluorescein Angiography / methods
  • Fundus Oculi
  • Humans
  • Retinal Vessels / diagnostic imaging
  • SARS-CoV-2
  • Tomography, Optical Coherence / methods