Case Report:
A male patient aged 41-years felt a mild cough followed by fever and also anosmia on October 14, 2020. He had previous contact with a COVID-19 family member with whom he was staying, but no prior history of traveling outside of the country prior to this occurrence. As his family history was positive, he went for RT-PCR testing for SARS-CoV-2 and became positive as COVID-19 on 16th October, 2020 and was in isolation at home. On the next day, 17th October, he had fever with dry cough constantly, sore throat followed by fatigue. His temperature was 104 °F, blood pressure 130/70 mmHg, pulse rate 98 bpm (regular) and oxygen saturation on pulse-oximetry was 98-99 % without oxygen. Routine blood tests or chest X-ray was not done on that time. The patient started medications from October 17, 2020 (Table 1). On 22th October 2020, physical examination indicated normal vital signs. Throughout this time, he had a mild covid symptom and was self-medicating at home, with no need for hospitalization. On 10th November 2020, the patient went for COVID-19 test that was negative and was completely stable without any complication. After the symptom free from Covid-19, December 2020, he was diagnosed as systemic hypertensive and started medication (Table 1) as recently six months diagnosed as hypertension without no other history of any significant co-morbidities. Later on, he gave his 1stdose of COVID-19 vaccine which was Live-virus vectored based vaccine (COVISHIELD vaccine-AstraZeneca) on 16 February 2021. He completed his 2nd dose of vaccine on 17 April 2021. From 1st dose of vaccine up to completing date of 2nd dose of vaccine he had no complication arises. Although the patient complaints of fatigue that last for 4 months after acute COVID-19. He had no history of diabetic and no history of Rheumatoid arthritis or no trauma of history on eye previously. He noticed 3-4 number floaters in his right eye on June 1, 2021, which changed or grew dramatically. Other complaints were light flashes, a curtain moving into and obstructing his vision, and diminished vision in his right eye and became red in colour on right eye. He had no complaints of watering of eye, headache, eye ache, eyelid swelling, any foreign body sensation. He had no other history of any trauma on eye or previous eye operations. On, 7th June, 2021, he went to ophthalmologist of the Ispahani Islamia Eye Institute and Hospital, Dhaka for this complication. Details of eye examination finding are given in (Table 2) . and fundus of R/E: Total vitreous hemorrhage shows in figure 1 and other blood investigation (Table 1) was also done and on same day he had immediately underwent Yag Laser Hyalodotomy as outdoor base case. He was discharged on same day and advised with medication (Table 2). On, 19 June, 2021 and 26 June, 2021 two outdoor follow up done with medication (Table 2) as continue treatment. Then, on July 28, 2021, it appeared to be clearing in some stages, but it was still a nonrevolving vitreous haemorrhage. Following that, he was scheduled to undergo Pars plana vitrectomy (PPV) with endolaser and anti-vascular endothelial growth factor (anti-VEGF) medications by an ophthalmologist at the Ispahani Islamia Eye Institute and Hospital in Dhaka. On, 29 July, 2021 he went to india for further follow-up and visited Sankara Nethralaya eye hospital, Chennai, India and done Ultrasound biomicroscopy (UBM) on 31 July, 2021 (Figure 2) and found on the right eye, there was a retinal detachment as well as a complete posterior vitreous detachment, and the vitreous displayed a large number of low reflective dot mobile echoes. On, 3rd August 2021, he again consults with doctor and advise to do OPTOS Retinal Exam and examination revealed plenty of low reflective dot and clump echos on right eye (Table 3). He continues his eye drop medication. For further better management, he planned to go LV Prasad eye institute, Hydarabed on 11th August 2021. As recommended by an ophthalmologist, the operation was conducted properly and he was discharged from the hospital that day in a stable condition with medicine. Procedure done successfully and discharged from hospital in a stable condition on same day with medication. On follow-up, 16 August, 2021, eye examination, On right eye examination: eyelids edematous, conjunctiva chemosis, cornea clear (Table 3). During the whole period scenario, physician not found any significant cause of this retinal haemorrhage except may be complication of post COVID or vaccine related retinal complication. Last follow up in Bangladesh on 6 October 2021, VAR:6/6 and VAL:6/6.
In summary, this patient was diagnosed COVID-19 on 16 October, 2020 (RT-PCR positive) and nasopharyngeal swab for SARS-CoV-2 was negative on 10th November 2020. The patient took first dose of COVID-19 vaccine (Live-virus vectored based vaccine, COVISHIELD vaccine-AstraZeneca) on the 16th February 2021 and 2nddose on 17th April 2021. Retinal hemorrhage was seen on 1st June,2021 and underwent Yag Laser Hyalodotomy and medication in Dhaka on 7 June, 2021.Then he went to chennai eye hospital, India and go through further investigation. Later on, again he admitted into the Hydarabed hospital on 12th August 2021 for right sided Pars plana vitrectomy (PPV) and later was discharged on same day. His blood pressure and random blood sugar levels were both normal at the time of ocular manifestation. During follow-upon in Bangladesh on 6 October 2021, visual acuity 6/6. indicating that his eye clinical condition had improved There was no further occurrence of hemorrhage after this follow-up.