Retinal Findings and Pitfalls of Optical Coherence Tomography Evaluation of The Inner Retina in Covid-19 Patients

Abstract Background: COVID-19 can cause retinal manifestations however, there are still gaps in the scientific literature about the repercussions of the disease on the retina, as well as concerns about the interpretation of the background and optical coherence tomography.Objective: To describe fundus findings in post-COVID-19 infection patients and evaluate the hyper-reflective images in the retinal ganglion cell layer (RGCL), with optical coherence tomography angiography (OCTA), to avoid imaging interpretation pitfalls.Methods: Cross-sectional study with analysis of thirty-eight eyes of nineteen confirmed COVID-19 infected patients was perfomed. The color fundus photography, optical coherence tomography (OCT), and OCTA were used. COVID-19 positive patients were included in the study and they were treated at a Brazilian referral hospital in July 2020. The study was approved by the Human Research and Ethics Committee.Results: The fundus abnormalities observed were the superficial hemorrhages 4/19 (21%) and cotton wool spots 1/19 (5,2%). We noticed hyper-reflective images on the ganglion cell layer corresponding to the physiologic macular vascular network vessels in all eyes. Follow-up scans examinations revealed pitfalls with the disappearance of some of the hyper-reflective images. Conclusion: Retinal superficial hemorrhage and cotton wool spots are unspecific findings usual to COVID-19 and others virus infections. Evaluating these findings with a multimodal imaging technique is recommended to avoid pitfalls and misinterpretation of hyper-reflective intraretinal images in OCT scans.