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.