COVID-19 associated with a purtscher-like retinopathy

OCT showed inner retinal hyperreflectivity, diffuse retinal thickening with intraretinal fluid, and a serous macular detachment.

Marco Pastore, MD, from the Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy, and colleagues reported a patient with acute painless vision loss in both eyes. The visual acuity decreased to counting fingers. The appearance of the retina and optic disc was found to be associated with the SARS-CoV-2 virus.

The investigators described that the ophthalmoscopic examination showed “multiple polygonal areas of retinal whitening at the posterior pole and around the optic disc associated with mild optic disc edema, nerve fiber layer infarcts, and macular edema with pseudo-cherry red spot” in both eyes.

The results of optical coherence tomography imaging showed “inner retinal hyperreflectivity, diffuse retinal thickening with intraretinal fluid, and a serous macular detachment.”

The investigators diagnosed an paracentral acute middle maculopathy that was associated with capillary nonperfusion of the intermediate and deep capillary plexuses.

The patient underwent testing for the SARS-CoV-2 virus, and polymerase chain reaction confirmed the infection.

Laboratory tests showed that both the C-reactive protein and D-dimer levels were increased. The patient was negative for any infectious diseases. The authors diagnosed Purtscher-like retinopathy associated with COVID-19. Treatment included intravenous methylprednisone (1,000-mg dose) for 7 days followed by oral corticosteroids.

Two months after the initial presentation, the vision improved from counting fingers to 20/32 and 20/25 in the right and left eyes, respectively. In addition, the authors reported that the detachment resolved with focal subfoveal ellipsoid zone disruption and reduced hyperreflectivity in the inner nuclear layer and outer plexiform layer.

Reference

Pastore MR, Furlanis G, Tognetto D. Bilateral Purtscher-like retinopathy associated with SARS-CoV-2 infection. JAMA Ophthalmol 2022;140(2):e214979. doi:10.1001/jamaophthalmol.2021.4979