Results
Mean patient age was 68.32 ± 9.97 years, 35 patients were followed up and treated with non-invasive mechanical ventilation and 58 patients with invasive mechanical ventilation support (Table 1). Patients were treated in the hospital for an average of 7 days from the onset of Covid-19 symptoms. Due to the clinical worsening, the patients were followed and treated in the intensive care unit, and ophthalmological examination was also performed in the intensive care unit. Ophthalmological examinations were performed after an average of 12.43 (2-30) days of admission to intensive care (Table 2). It was observed in the files of the patients that no ocular symptoms were reported in any of the patients.
Patients who developed severe chemosis were those who were occasionally placed in the prone position for treatment. Severe keratitis due to lagophthalmos was detected in 1 patient, conjunctivitis with the purulent discharge was detected in 1 patient, and eye closure and drug treatment (moxifloxacin and artificial tear without preservative) were initiated. When these patients were examined for control purposes, improvement was observed in patients with corneal abrasion, but treatment responses could not be followed up in the patient with keratitis and purulent conjunctivitis considering that the patients were dead. In two of the cases with conjunctivitis, PCR test was performed from conjunctival swabs to detect SARS-CoV-2, but a negative result was obtained.
Apart from retinal involvement due to systemic diseases, new intraretinal haemorrhages were observed in 8 patients (8.6%). Bilateral haemorrhages were observed in 1 patient and splinter haemorrhages in the temporal side of the optic disc were observed in 2 patients. Cotton wool spots together with splinter haemorrhage in the temporal side of the optic disc were observed in 1 patient. In 4 patients, intraretinal haemorrhages were observed in the macula in the arch. One of the patients who had haemorrhage in the arch also had cerebral haemorrhage and bilateral papilloedema. There was no statistically significant difference in both comorbid systemic diseases and findings of laboratory parameters of these patients. The distribution and comparison of systemic disease and laboratory parameters of patients with retinal haemorrhage compared to other patients are shown in Table 3.
Of the 93 patients followed, 19 (20%) patients survived, whereas other patients were lost due to complications due to Covid-19. 14 (15.05%) of the 19 patients were followed up and treated with non-invasive ventilation, 5 (5.3%) were treated with mechanical ventilation, and their treatment continued in the ward when the intensive care requirements decreased.