Portal de Periódicos da CAPES

Retinal findings in COVID-19 patients with diabetes mellitus

2020; Elsevier BV; Volume: 168; Linguagem: Inglês

10.1016/j.diabres.2020.108395

1872-8227

Noemí Güemes-Villahoz, Barbara Burgos‐Blasco, J. Donate-López, J. García–Sánchez,

Intraoperative Neuromonitoring and Anesthetic Effects

We read with great interest the correspondence by Dr. Raony and Dr. Saggioro de Figueiredo, describing the possible role of CD147 in retinal findings observed in coronavirus disease 2019 (COVID-19) patients with diabetes mellitus (DM) [[1]Raony Í. Saggioro de Figueiredo C. Retinal outcomes of COVID-19: Possible role of CD147 and cytokine storm in infected patients with diabetes mellitus.Diabetes Res Clin Pract. 2020; 165: 108280Abstract Full Text Full Text PDF Scopus (14) Google Scholar]. Recent experimental and clinical findings suggested transmembrane glycoprotein CD147, also termed Basigin, may represent a novel receptor for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) entry into host cells [[2]Wang K, Chen W, Zhou Y-S, Lian J-Q, Zhang Z, Du P, et al. SARS-CoV-2 invades host cells via a novel route: CD147-spike protein. bioRxiv [Internet]. 2020 Jan 1;2020.03.14.988345. Available from: http://biorxiv.org/content/early/2020/03/14/2020.03.14.988345.abstract.Google Scholar]. Since CD147 is expressed at moderate-to-high levels in human retina [[3]Hamashima K, Gautam P, Lau KA, Khiong CW, Blenkinsop TA, Li H, et al. Potential modes of COVID-19 transmission from human eye revealed by single-cell atlas. bioRxiv [Internet]. 2020 Jan 1;2020.05.09.08561Available from: http://biorxiv.org/content/early/2020/05/14/2020.05.09.085613.abstract.Google Scholar] and has also proven to be an essential molecule for blood-retinal barrier impairment in streptozotocin-induced diabetic mice [[4]Arima M. Cui D. Kimura T. Sonoda K.-H. Ishibashi T. Matsuda S. et al.Basigin can be a therapeutic target to restore the retinal vascular barrier function in the mouse model of diabetic retinopathy.Sci Rep [Internet]. 2016; 6 (Available from): 38445http://www.ncbi.nlm.nih.gov/pubmed/27917946Crossref PubMed Scopus (21) Google Scholar], the authors suggested an intriguing hypothesis. At present we are passing through a phase of slow and difficult understanding of the clinical spectrum and the emerging short- and long-term complications caused by SARS-CoV-2 infection. In this sense, the retinal involvement has drawn attention as a possible biomarker of microangiopathy in COVID-19 patients [[5]Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, et al. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med [Internet]. 2020 Jul 30; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32729633.Google Scholar]. Marinho et al. reported cotton wool spots (CWS) and microhemorrhages in patients with COVID-19 [[6]Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R. Retinal findings in patients with COVID-19. Lancet (London, England) [Internet]. 2020;395(10237):1610. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32405105.Google Scholar]. However, these findings have been strongly questioned by other authors [[7]Vavvas DG, Sarraf D, Sadda SR, Eliott D, Ehlers JP, Waheed NK, et al. Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent Lancet publication. Eye (Lond) [Internet]. 2020 Jul 9; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32647303.Google Scholar]. Additionally, Landecho et al. recently reported CWS in 6 out of 27 patients evaluated 14 days after hospital discharge due to COVID‐19 bilateral pneumonia [[5]Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, et al. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med [Internet]. 2020 Jul 30; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32729633.Google Scholar]. CWS represent retinal nerve fiber layer infarcts and may appear in a broad spectrum of diseases, such as diabetic retinopathy and hypertensive retinopathy among others [[5]Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, et al. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med [Internet]. 2020 Jul 30; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32729633.Google Scholar]. As arterial hypertension and DM are common comorbidities encountered in hospitalized patients with COVID-19, it is unclear if CWS represent a true retinal microangiopathy associated with SARS-CoV-2 infection, retinal lesions prior to infection or simply clinical abnormalities related to uncontrolled diseases during the infection. Our research team has conducted several studies in COVID-19 patients [8Burgos-Blasco B, Güemes-Villahoz N, Donate-Lopez J, Vidal-Villegas B, García-Feijóo J. Optic nerve analysis in COVID-19 patients. J Med Virol [Internet]. 2020 Jul 10; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32648939.Google Scholar, 9Güemes-Villahoz N, Burgos-Blasco B, Arribi-Vilela A, Arriola-Villalobos P, Vidal-Villegas B, Mendez-Fernandez R, et al. SARS-CoV-2 RNA detection in tears and conjunctival secretions of COVID-19 patients with conjunctivitis. J Infect [Internet]. 2020 Jun 3; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32504746.Google Scholar, 10Güemes-Villahoz N, Burgos-Blasco B, Vilela AA, Arriola-Villalobos P, Luna CMR, Sardiña RC, et al. Detecting SARS-CoV-2 RNA in conjunctival secretions: is it a valuable diagnostic method of COVID-19? J Med Virol [Internet]. 2020 Jun 24; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32579256.Google Scholar]. We evaluated a larger sample that included 80 laboratory-confirmed COVID-19 patients (160 eyes). Clinical characteristics of the patients are shown in Table 1. Examination was performed 30 days (28–32) after COVID-19 diagnosis. Every patient underwent fundus examination and optical coherence tomography (OCT). Funduscopic examination of all patients was unremarkable, not revealing cotton wool spots nor retinal hemorrhages.Table 1Demographic and clinical characteristics of COVID-19 patients.VariableN=80Sex Male. No (%)39 (48,8)Female. No (%)41 (51,3)Age. Mean (SD)55,8 (8,7)Medical historyAH. No (%)20 (25,0)DM. No (%)6 (7,5)DL. No (%)21 (26,3)Clinical severity Mild. No (%)27 (33,8)Moderate. No (%)20 (25,0)Severe. No (%)33 (41,3) Open table in a new tab Considering these contradictory data, further research on COVID-19 retinal outcomes is warranted. We commend the authors on the interesting hypothesis. Whether SARS-CoV-2 infection may precipitate or exacerbate retinal lesions in patients with DM in the short- or long-term requires to be carefully evaluated. No funding has been received for the preparation of this manuscript.