The proposed SARS-CoV-2-induced dysregulation of the renin-angiotensin-aldosterone (RAAS) system results in endothelial dysfunction and microvascular thrombosis. The retinal plexuses contain terminal vessels without anastomotic connections, making the retina especially susceptible to ischemia. This study aimed to determine the role of selected polymorphisms of genes in the RAAS pathway in COVID-19 severity and their association with the presence of COVID-19 retinopathy. 69 hospitalized patients in the acute phase of COVID-19 without known systemic comorbidities and 96 healthy controls were enrolled in this prospective cross-sectional study. The retina was assessed with fundus photography using a Topcon DRI OCT Triton (Topcon Corp., Tokyo, Japan) in the COVID-19 unit. Genotyping of selected polymorphisms in the genes for ACE (rs4646994), ACE2 (rs2285666), and AGTR2 (rs1403543) was performed. The COVID-19 group was divided into mild (n = 12) and severe (n = 57), and then further divided according to the presence of COVID-19 retinopathy (Yes, n = 50; No, n = 19). The presence of the AGTR2 rs1403543-AA genotype was associated with a 3.8-fold increased risk of COVID-19 retinopathy (p = 0.05). The genotype frequencies of selected gene polymorphisms were not significantly associated with either the presence of COVID-19 or its severity. This is the first study demonstrating a borderline association of the AGTR2 rs1403543-AA genotype with COVID-19 retinopathy in males; hence, the AGTR2 rs 1403543 A allele might represent a genetic risk factor for COVID-19 retinopathy in males.

This study aimed to quantify possible long-term impairment of the retinal microcirculation and microvasculature by reassessing a cohort of patients with acute COVID-19 without other known comorbidities one year after their discharge from the hospital. Thirty patients in the acute phase of COVID-19 without known systemic comorbidities were enrolled in this prospective longitudinal cohort study. Fundus photography, SS-OCT, and SS-OCTA using swept-source OCT (SS-OCT, Topcon DRI OCT Triton; Topcon Corp., Tokyo, Japan) were performed in the COVID-19 unit and 1-year after hospital discharge. The cohort’s median age was 60 years (range 28–65) and 18 (60%) were male. Mean vein diameter (MVD) significantly decreased over time, from 134.8 μm in the acute phase to 112.4 μm at a 1-year follow-up (p < 0.001). A significantly reduced retinal nerve fiber layer (RNFL) thickness was observed at follow-up in the inferior quadrant of the inner ring (mean diff. 0.80 95% CI 0.01–1.60, p = 0.047) and inferior (mean diff. 1.56 95% CI 0.50–2.61, p < 0.001), nasal (mean diff. 2.21 95% CI 1.16–3.27, p < 0.001), and superior (mean diff. 1.69 95% CI 0.63–2.74, p < 0.001) quadrants of the outer ring. There were no statistically significant differences between the groups regarding vessel density of the superior and deep capillary plexuses. The transient dilatation of the retinal vessels in the acute phase of COVID-19, as well as RNFL thickness changes, could become a biomarker of angiopathy in patients with severe COVID-19.

Kristina Jevnikar, Polona Jaki Mekjavić, Nataša Vidovič Valentinčič, Aleš Ambrožič, Alojzija Hočevar; Central retinal vein and cilioretinal artery occlusio

Background: This retrospective cohort study aimed to assess the characteristics of patients enrolled in the national diabetic retinopathy (DR) screening program and evaluate the selected program's quality elements in the first five years after implementation. Methods: Patients who underwent DR screening between February 2018 and June 2022 at the University Medical Centre Ljubljana were included. General patient characteristics (age, sex, type and therapy of diabetes mellitus (DM), duration of DM, blood HbA1c levels), best corrected visual acuity, stage of DR, presence of sight-threatening diabetic retinopathy (STDR), and selected quality indicators (quality of photographs, re-screening interval, time to treatment) were recorded and evaluated. Results: A total of 34 654 screening examinations were performed on 13 513 patients with diabetes. The majority (77.3%) had Type 2 diabetes, with a mean DM duration of 9.74 ± 9.87 years. In 55.9% of patients, DM duration was less than ten years, and the mean HbA1c was 7.33% ± 1.49. DR signs were noted in 29.1% of patients and 0.89% of patients exhibited STDR. After establishing the diagnosis of STDR, treatment was initiated in 3.43 ± 1.98 months. Conclusion: Implementing the DR screening program provides valuable insights into managing diabetic retinopathy nationwide. It allows for the early detection of sight-threatening DR and facilitates timely and effective treatment, which could help prevent severe visual impairment.

Purpose: The aim of this retrospective study was to evaluate the long-term visual outcomes of patients with various etiologies of uveitis, undergoing cataract surgery and to identify possible factors influencing the visual outcome and the rate of postoperative complications. Methods: Patients who underwent cataract surgery between January 2015 and February 2020 were included. Results: A total of 102 eyes of 78 patients were included in this study. There was a statistically significant difference in the postoperative BCVA between the groups based on anatomical localization as well as etiology. Standard procedure with phacoemulsification and lens implantation was associated with statistically significant better final BCVA than surgery with an additional iris procedure. Conclusions: Visual outcome varies between the subtypes of uveitis. Post-operative BCVA correlates strongly with preoperative values; prolonged delay of surgery may not be indicated. Meticulous control of pre-operative inflammation, peri-operative treatment adjustment, and close postoperative follow-up is essential for a favorable outcome.

BACKGROUND Central retinal vein occlusion (CRVO) is associated with cardiovascular risk factors, but hypercoagulability, endothelial dysfunction, and stasis of blood present in patients with chronic obstructive pulmonary disease (COPD) may also play a role in its pathogenesis. This report describes the case of a 70-year-old woman who presented with reduced vision in the right eye due to CRVO. CASE REPORT A 70-year-old woman with a history of smoking presented with decreased vision in the right eye. Except for well-controlled hyperlipidemia, she lacked the classic CRVO risk factors. The workup showed elevated polyclonal free light chains (FLCs), elevated Beta-2 microglobulin (ß2M), and anemia. A thorough history-taking revealed involuntary weight loss, morning headaches, fatigue, a productive morning cough with white sputum, and shortness of breath over the past 3 months. Clinical ophthalmological examination, multimodal imaging, extensive laboratory workup, and clinical workup were performed and the results were consistent with CRVO. After pulmonary examination, spirometry, and thorax imaging, she was diagnosed with COPD. CONCLUSIONS COPD can be a potential underlying condition in patients presenting with CRVO that cannot be attributed to other etiologies, particularly if they have a past medical history suggestive of COPD. An emphasis should be placed on inquiries regarding the main symptoms of COPD: shortness of breath, morning cough, and sputum production. A further pulmonary examination may be beneficial in patients with CRVO and smoking history, given that early diagnosis of COPD prolongs survival.