Fundus findings in patients admitted with post COVID-19 sepsis in an intensive care unit

PURPOSE: COVID-19 infection is being increasingly identified as a risk factor for the development of ocular infections, especially endogenous endophthalmitis. Current studies primarily report cases among survivors, and the overall prevalence, especially amongst patients admitted with active sepsis is unknown. We report on the fundus and systemic findings of inpatients who were being treated for post-COVID-19 systemic secondary infections in a tertiary intensive care unit. METHODS: Retrospective observational study based on chart review. RESULTS: A total of 24 patients were identified. These included 21 (87.5%) males and 3 (12.5%) females with ages ranging from 33 to 72 years (mean 54.1 years). Pre-existing risk factors included type 2 diabetes mellitus, systemic hypertension, chronic kidney disease, multiple myeloma, and patients on long-term corticosteroid/immunosuppressive treatment. Nine patients (37.5%) died and 15 (62.5%) survived. Of a total of 48 eyes, observed fundus lesions included endogenous endophthalmitis (4 eyes of 2 patients, 8.3%), preretinal hemorrhages (4 eyes of 2 patients, 8.3%), optic disc pallor (2 eyes of 1 patient, 4.1%), moderate non-proliferative diabetic retinopathy (4 eyes of 2 patients, 8.3%), Roth spots (2 eyes of 1 patient, 4.1%), and 2 eyes of 1 patient (4.1%) with evidence of previous pan-retinal photocoagulation. CONCLUSION: Two patients had evidence of endogenous endophthalmitis. These findings suggest that the actual incidence of ocular lesions, especially infections is higher than that reported. Fundus examination should form a part of the management protocol for patients being treated for post-COVID-19 systemic infections.