Clinical features of certain ophthalmological conditions in the context of chronological comorbidity

PURPOSE. To monitor patients with type 2 diabetes mellitus who developed age-related macular degeneration (AMD) following a COVID-19 infection.
METHODS. The study included 58 patients who underwent a comprehensive examination, they were equally divided into two groups. The main group consisted of 29 patients with type 2 diabetes mellitus and late-stage age-related macular degeneration (AREDS IV) that developed following a COVID-19 infection. In the control group of 29 patients, 12 (41%) had no history of ocular diseases prior to COVID-19, while 17 (59%) had been diagnosed with the dry form of AMD (AREDS I) before the infection.
RESULTS. Central retinal thickness (CRT) correlated with the level of glycated hemoglobin (r=0.80; p<0.05) and C-reactive protein (r=0.43; p<0.05). The mean CRT was 274.3±3.1 μm; best corrected visual acuity (BCVA) — 0.03±0.01; C-reactive protein — 40.03±2.00 mg/L; D-dimer — 150±3.0 ng/mL; and glycated hemoglobin (HbA1c) — 10.6±0.2%. Among study patients, those with elevated levels of C-reactive protein and D-dimer had visual acuity ranging from 0.01 to 0.09, while intraocular pressure remained within normal limits. A favorable trend was associated with a decrease in CRT. The article also presents a clinical case of a patient with AMD, choroidal neovascularization evolving into a fibrotic form, nonproliferative diabetic retinopathy, stage IIIА open-angle glaucoma, a history of partial vitreous hemorrhage, and subretinal bleeding following COVID-19 infection. The hypotensive regimen included a fixed combination of bimatoprost 0.3 mg/mL and timolol 5 mg/mL (Bimokko-SZ), dorzolamide (Dorzolamide-SZ), and brimonidine (Brimonidine-SZ; all medications manufactured by NAO Severnaya Zvezda, Russia).
CONCLUSION. Patients with type 2 diabetes and AMD that developed after COVID-19, accompanied by severe vision loss and elevated biochemical markers of inflammation and thrombogenesis, require regular follow-up and an interdisciplinary approach.

1. Khan M, Adil SF, Alkhathlan HZ et al. COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules 2020; 26(1):39. https://doi.org/10.3390/molecules26010039.

2. Gaibaryan RV, Nagibin ER. Ophthalmological aspects of COVID-19. Enigma 2021;38:113-118.

3. Babaei M., Bayani M., Farzin M., Rasoulinejad S.A. The Association of Clinical Symptoms and Coexistent Clinical Conditions with Ophthalmic Manifesting in COVID-19 Patients. Caspian J Intern Med 2022; 13(Suppl 3):180-186. https://doi.org/10.22088/cjim.13.0.180.

4. Nanayakkara N., Curtis A.J., Heritier S., et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia 2021; 64(2): 275-287. https://doi.org/10.1007/s00125-020-05319-w.

5. Sharma P., Behl T, Sharma N et al. COVID-19 and diabetes: Association intensify risk factors for morbidity and mortality. Biomedicine & Pharmacotherapy 2022; 151:113089. https://doi.org/10.1016/j.biopha.2022.113089.

6. Nassar M, Daoud A, Nso N et al. Diabetes Mellitus and COVID-19: Review Article. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2021; 15(6):1871-4021. https://doi.org/10.1016/j.dsx.2021.102268.

7. Basra R, Whyte M, Karalliedde J et al. What is the impact of microvascular complications of diabetes on severe COVID-19? Microvascular Research 2022; 140:104310. https://doi.org/10.1016/j.mvr.2021.104310.

8. 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: 108280. https://doi.org/10.1016/j.diabres.2020.108280.

9. Zhou L., et al. Expression of the SARS-CoV-2 Receptor ACE2 in Human Retina and Diabetes-Implications for Retinopathy. Invest Ophthalmol Vis Sci. 2021; 62(7):6. https://doi.org/10.1167/iovs.62.7.6.

10. Alamin A., Mahmoud I, Musa A et al. Clinical characteristics and outcomes of COVID-19 hospitalized patients with diabetes in the United Kingdom: A retrospective single centre study. Diabetes Research and Clinical Practice 2020; 165:108263. https://doi.org/10.1016/j.diabres.2020.108263.

11. Sultan S., Sultan M. COVID-19 cytokine storm and novel truth. Medical Hypotheses 2020; 144. https://doi.org/10.1016/j.mehy.2020.109875.

12. Kurchatova N.N. Features of the immune status of a patient with diabetic nonproliferative retinopathy after suffering from COVID-19. Medical Bulletin of Bashkortostan 2021; 4(94):49-53.

13. Larrea J, Villota-Deleu E, Fernández-Vega B, Fernández-Vega Sanz Á. Late retinal and optic nerve vascular complications due to COVID-19 in young individuals. Am J Ophthalmol Case Rep 2022; 25:101327. https://doi.org/10.1016/j.ajoc.2022.101327.

14. Galimova A.B. A clinical case of combined occlusion of the central artery and vein of the retina against the background of a new coronavirus infection. Medical Bulletin of Bashkortostan 2021; 4(94): 36-39.

15. Jiang, B., Gao, L., Dong, S. et al. The Influence of COVID-19 on the Stability of Patients with Neovascular Age-Related Macular Degeneration with Different Treatment Regimens. Adv Ther 2022; 39(4):1568- 1581. https://doi.org/10.1007/s12325-021-01993-3.

16. Szegedi S, Ebner C, Miháltz K, Wachter T, Vécsei-Marlovits PV. Longterm impact of delayed follow-up due to COVID-19 lockdown on patients with neovascular age-related macular degeneration. BMC Ophthalmol 2022; 22(1):228. https://doi.org/10.1186/s12886-022-02453-4.

17. Borrelli E., Grosso D, Vella G et al. Short-term outcomes of patients with neovascular exudative AMD: the effect of COVID-19 pandemic. Graefes Arch Clin Exp Ophthalmol 2020; 258(12):2621-2628. https://doi.org/10.1007/s00417-020-04955-7.

18. Stattin M, Ahmed D, Graf A et al. The Effect of Treatment Discontinuation During the COVID-19 Pandemic on Visual Acuity in Exudative Neovascular Age-Related Macular Degeneration: 1-Year Results. Ophthalmol Ther 2021; 10(4):935-945. https://doi.org/10.1007/s40123-021-00381-y.

19. Ullah I, Sohail A, Shah MUFA et al. Central Retinal Vein Occlusion in patients with COVID-19 infection: A systematic review. Annals of Medicine and Surgery 2021; 71:102898. https://doi.org/10.1016/j.amsu.2021.102898.

20. Ramesh SV, Ramesh PV, Ramesh MK et al. COVID-19-associated papilledema secondary to cerebral venous thrombosis in a young patient. Indian J Ophthalmol 2021; 69(3):770-772. https://doi.org/10.4103/ijo.IJO_2660_20.

21. Feizi S, Meshksar A, Naderi A et al. Anterior Scleritis Manifesting After Coronavirus Disease 2019: A Report of Two Cases. Cornea 2021; 40(9):1204-1206. https://doi.org/10.1097/ICO.0000000000002795.

22. Yang J.M., et al. COVID-19 Morbidity and Severity in Patients with Age-Related Macular Degeneration: A Korean Nationwide Cohort Study. American Journal of Ophthalmology 2024; 268: 159-169. https://doi.org/10.1016/j.ajo.2024.09.004.