COVID-19: Increased incidence of RVOs post-diagnosis

California researchers led by Bobeck S. Modjtahedi, MD, from the Department of Research and Evaluation, Southern California Permanente Medical Group, Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, both in Pasadena, and the Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, and colleagues reported that the incidence of retinal vein occlusions (RVOs) but not retinal artery occlusion (RAOs), increased in the 6 months after COVID-19 diagnosis.¹

The investigators conducted a large cohort study of 432,515 patients to determine if the incidence of RVOs occlusions changed in the half year after COVID-19 was diagnosed.

The study patients included those diagnosed with COVID-19 from January 20, 2020 to May 21, 2021, but no history of an RVO.

Patients were excluded who had a history of a RAO or RVO more than 6 months before they were diagnosed with COVID-19.

The primary outcome measure was the change in the average biweekly incidence of new RAOs and RVOs after COVID-19 was diagnosed.

Incidence of RVOs

The authors reported that 16 patients had an RAO (crude incidence rate, 3.00 per 1,000,000 patients), and 65 had an RVO (crude incidence rate, 12.20 per 1,000,000 patients) in the 6 months after COVID-19 was diagnosed.

The incidence of new RVOs was significantly (p=0.03) higher in the 6 months after COVID-19 infection compared with the 6 months before infection after adjusting for various factors, with the peak incidence of the RVOs occurring 6 to 8 weeks after COVID-19 was diagnosed.

A smaller nonsignificant (p=0.44) increase in the incidence of RAOs was seen after COVID-19, with the peak occurring at 10 to 12 weeks after COVID-19 was diagnosed.

The primary finding was that the incidence of RVOs but not RAOs increased during the 6 months after COVID-19 was diagnosed.

The authors believe that the increased risk of RVO in the 6 months after COVID-19 is diagnosed is in line with the increased risk of systemic vascular damage reported with COVID-19^,2-4 and physicians should be alert to this.

References

1. Modjtahedi BS, Do D, Luong TQ, Shaw J. Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis. JAMA Ophthalmol Published online April 14, 2022. doi:10.1001/jamaophthalmol.2022.0632

2. Go AS, Reynolds K, Tabada GH, et al.COVID-19 and risk of VTE in ethnically diverse populations.Chest. 2021;160:1459-1470. doi:10.1016/j.chest.2021.07.025

3. Piazza G, Campia U, Hurwitz S, et al. Registry of arterial and venous thromboembolic complications in patients with COVID-19. J Am Coll Cardiol 2020;76:2060-2072. doi:10.1016/j.jacc.2020.08.070

4. Lodigiani C, Iapichino G, Carenzo L, et al., Humanitas COVID-19 Task Force. 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