Abstract

DEVELOPMENT OF OCULAR ALTERATIONS IN PATIENTS WITH SEVERE COVID-19 UNDER INVASIVE MECHANICAL VENTILATION AND PROLONGED PRONATION

Zaira Lizette Jiménez Díaz, Julio Alejandro Blanco D Mendieta, Arturo Carrasco Quiroz, Lizbeth Karina Blanco D. Mendieta and José D. Méndez*

Abstract

This work was designed to investigate ocular alterations in patients affected by severe COVID-19 who required invasive mechanical ventilation and prolonged pronation to optimize lung ventilation areas. The study was conducted in the Intensive Care Unit of the Specialties Hospital of the XXI Century National Medical Center, Mexican Institute of Social Security. 45 patients who required hospitalization between the months of March and May 2021 were included. Both eyes were analyzed in each patient. The mean age of the patients was 60 years. 68.9 % had comorbidities. The most frequent findings in adnexa were blepharoedema and chemosis. In the ocular fundus, several alterations including cotton-wool lesions, intraretinal hemorrhages and arteriolar vasoconstriction were observed. The effect of the hours of pronation on the frequency of retinal alterations was statistically significant the group of patients without changes against those who had more than two retinal alterations. Having more than 145 hours of pronation increases the risk of having more than two retinal alterations. Intraocular pressure increased in pronation by 61 % with P < 0.05. The ocular alterations in patients with COVID-19 under invasive mechanical ventilation and prolonged pronation range from the ocular adnexa to the alterations in the fundus of the eye. The relevance of this study lies in the fact that the patients were examined during the most severe period of the disease, where more systemic ischemic alterations could have manifested. These results suggest the need to implement a protocol for the primary and secondary prevention of ocular complications in patients with COVID-19, but which may be useful for patients who must remain in prolonged pronation for other medical indications.

Keywords: Coronavirus Infection, Intensive Care Unit, Intubation, Intratracheal Airway Management, Pronation, Ocular Damage.