Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena.
Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
JAMA Ophthalmol. 2022 May 1;140(5):523-527. doi: 10.1001/jamaophthalmol.2022.0632.
COVID-19 is associated with systemic vascular damage; however, the risk posed to the retinal vasculature remains incompletely understood.
To assess if there is a change in the incidence of retinal vascular occlusions after COVID-19 infection.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study at an integrated health care organization (Kaiser Permanente Southern California) included patients without a history of retinal vascular occlusion who were diagnosed with COVID-19 infection between January 20, 2020, and May 31, 2021. Patients were excluded if they had a history of retinal artery occlusions (RAOs) or retinal vein occlusions (RVOs) more than 6 months before their COVID-19 diagnosis or if they were enrolled in Kaiser Permanente Southern California for less than 6 months before COVID-19 diagnosis.
COVID-19 infection.
The change in the average biweekly incidence of new RAOs and RVOs after COVID-19 diagnosis. Adjusted incidence rate ratios (IRRs) were calculated to compare the incidence of retinal vascular occlusions before and after COVID-19 diagnosis after accounting for baseline demographic characteristics, medical history, and hospitalization.
A total of 432 515 patients diagnosed with COVID-19 infection were included in this study. The mean (SD) age was 40.9 (19.2) years, and 231 767 patients (53.6%) were women. Sixteen 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 diagnosis. The incidence of new RVOs was higher in the 6 months after COVID-19 infection compared with the 6 months before infection after adjusting for age; sex; self-reported race and ethnicity; body mass index; history of diabetes, hypertension, or hyperlipidemia; and hospitalization (adjusted IRR, 1.54; 95% CI, 1.05-2.26; P = .03). There was a smaller increase in the incidence of RAOs after COVID-19 diagnosis (IRR, 1.35; 95% CI, 0.64-2.85; P = .44). The peak incidence of RAOs and RVOs occurred 10 to 12 weeks and 6 to 8 weeks after COVID-19 diagnosis, respectively.
The findings of this study suggest that there was an increase in the incidence of RVOs after COVID-19 infection; however, these events remain rare, and in the absence of randomized controls, a cause-and-effect relationship cannot be established. Further large, epidemiologic studies are warranted to better define the association between retinal thromboembolic events and COVID-19 infection.
COVID-19 与全身血管损伤有关；然而，视网膜血管所面临的风险仍不完全清楚。
评估 COVID-19 感染后视网膜血管闭塞的发生率是否发生变化。
设计、地点和参与者：这项在综合医疗保健机构（南加州凯撒医疗机构）进行的队列研究纳入了无视网膜血管闭塞病史且在 2020 年 1 月 20 日至 2021 年 5 月 31 日期间被诊断为 COVID-19 感染的患者。如果患者在 COVID-19 诊断前 6 个月以上有视网膜动脉闭塞（RAO）或视网膜静脉闭塞（RVO）病史，或在 COVID-19 诊断前在南加州凯撒医疗机构登记不足 6 个月，则将其排除在外。
COVID-19 感染。
COVID-19 诊断后新发 RAO 和 RVO 的平均每两周发生率的变化。计算了调整后的发病率比率（IRR），以在考虑基线人口统计学特征、病史和住院治疗后，比较 COVID-19 诊断前后视网膜血管闭塞的发生率。
本研究共纳入 432515 例确诊 COVID-19 感染的患者。平均（SD）年龄为 40.9（19.2）岁，231767 例患者（53.6%）为女性。COVID-19 诊断后 6 个月内，16 例患者发生 RAO（粗发病率为每 1000000 人 3.00 例），65 例患者发生 RVO（粗发病率为每 1000000 人 12.20 例）。COVID-19 感染后 6 个月内新发 RVO 的发生率高于感染前 6 个月，经年龄、性别、自我报告的种族和民族、体重指数、糖尿病、高血压或高血脂史以及住院治疗调整后（调整后的 IRR，1.54；95%CI，1.05-2.26；P=0.03）。COVID-19 诊断后 RAO 的发生率略有增加（IRR，1.35；95%CI，0.64-2.85；P=0.44）。RAO 和 RVO 的发病高峰分别出现在 COVID-19 诊断后 10 至 12 周和 6 至 8 周。
本研究结果表明，COVID-19 感染后 RVO 的发生率有所增加；然而，这些事件仍然很少见，并且由于缺乏随机对照，不能确定因果关系。需要进一步进行大型、流行病学研究，以更好地确定视网膜血栓栓塞事件与 COVID-19 感染之间的关联。
