case_images: PMC7714146_01
case_images: Color and red-free retinal photographs from patient #6 (W.A.C.).. Images acquired on day 64 after symptoms onset, from a 35 year-old obese and hypertensive man who was admitted on day seven since onset of fever, cough and dyspnea. During hospitalization, this patient evolved to critical illness, characterized by acute respiratory distress syndrome, respiratory failure and acute kidney injury, requiring ICU monitorization, mechanical ventilation and hemodialysis. The patient had a positive clinical outcome, and received hospital discharge on day 69 after symptoms onset. (A) Right retina showing a nerve fiber layer infarct above the optic nerve head, and microhemorrhages in the papillomacular bundle close to the optic disc. (B) Left retina showing nerve fiber layer infarcts at the inferior temporal vascular arcade, approximately 1.5 disc diameters inferior to the macula. Square and circular insets represent 2x magnification of the delimited area.
case_images: pone.0243346.g001.jpg
case_images: PMC7714146_01_pone.0243346.g001.jpg
case_images: pone.0243346.g001
case_images: Retinal examination was performed on day 59 post symptom onset, showing nerve fiber layer infarcts in both eyes, adjacent to the optic nerve head in the right eye (Fig 1A) and close to the inferior temporal vasculature in the left (Fig 1B). Upon reexamination 5 days later (day 64 shown in Fig 1), there were no changes in terms of intensity or extension of the lesions previously observed.
case_images: PMC7714146_02
case_images: Color and red-free retinal photographs from patient #18 (W.S.).. Images acquired on day 16 from symptoms onset, from a 56 year-old man with no comorbidities, admitted on day 13 after onset of a clinical scenario characterized by fever, cough, headache, myalgia and dyspnea. The patient evolved to severe illness, not requiring ICU monitorization nor developing any organ failure. Lung CT at admission revealed bilateral ground-glass opacities predominantly in the periphery, extending to approximately 50% of lung parenchyma. (A) Flame-shaped hemorrhage (arrow) approximately one disc diameter from the optic nerve head, close to the inferior temporal vascular arcade. (B) Same lesion observed from an alternative point of gaze fixation, magnified in the insets (2x; arrowheads).
case_images: pone.0243346.g002.jpg
case_images: PMC7714146_02_pone.0243346.g002.jpg
case_images: pone.0243346.g002
case_images: He presented with a unilateral flame-shaped lesion approximately one disc diameter from the optic nerve head, adjacent to the inferior temporal vascular arcade (Fig 2).
case_images: PMC7714146_03
case_images: Color and red-free retinal photographs from patient #19 (G.C.X.).. Images acquired on day 12 from symptoms onset, from a 49 year-old man in regular treatment for arterial hypertension, admitted on the eight day after onset of fever, cough, myalgia and progressive dyspnea. Lung CT on admission showed typical viral pneumonia findings extending through 25-50% of the parenchyma. The patient evolved to a severe phenotype of the disease. (A) Right retina presenting with isolated microhemorrhage at the periphery close to the inferior temporal vasculature. (B) Left retina showing isolated microhemorrhage at the inferior nasal retinal quadrant. Insets represent delimited areas with 2x magnification.
case_images: pone.0243346.g003.jpg
case_images: PMC7714146_03_pone.0243346.g003.jpg
case_images: pone.0243346.g003
case_images: He presented with isolated microhemorrhages in both eyes in the inferior retinal quadrant close to the vascular arcades (Fig 3).