Purpose

To report presenting features and outcome of patients diagnosed with primary choriocapillaropathy following COVID 19 illness and SARS-COV2 vaccination.

Methods

Retrospective, observational case series. Patients presenting with primary choriocapillaropathy within 6 weeks of COVID 19 illness (RTPCR positive) or SARS-COV2 vaccination without any alternative aetiology were included. Electronic medical records were reviewed and their presenting features and long-term outcomes were analysed.

Results

Seven eyes of 5 patients were included in the study. The disease was unilateral in 3. Two patients presented within 6 weeks of COVID 19 illness and three within 6 weeks of receiving SARS-COV2 vaccination. The mean age of presentation was 35.6 years (range: 25-50 years) and mean time to presentation was 32.2 days (range; 21-42 days). The phenotypic expression of choriocapillaropathies included multifocal choroiditis (n3), serpiginous choroiditis (n1), atypical AZOOR (n1) and atypical MEWDS (n1). The mean logMAR visual acuity at presentation was 0.35. Outer retinal involvement secondary to choriocapillary ischemia was a common finding in all these cases. Three of these patients were initiated on oral corticosteroids to which one patient responded while two had continued disease progression that responded to addition of intravitreal dexamethasone implant. One patient responded to intravitreal dexamethasone implant and intravitreal adalimumab therapy with no systemic treatment. At 6 months follow up, four out of five patients (one was lost to follow up) had complete resolution of ocular inflammation. The final mean logMAR visual acuity was 0.10. None of these patients had recurrence or required long term immunosuppression.

Conclusions

Primary choriocapillaropathies can occur after COVID-19 illness and SARS-COV2 vaccination. All of them responded well to a short course of oral steroids and/or intravitreal steroids without the requirement of long-term immunosuppression