Retinal nerve fibre layer and ganglion cell layer changes in children who recovered from COVID-19: a cohort study

Objective To investigate the optic nerve and macular parameters of children who recovered from COVID-19 compared with healthy children using optical coherence tomography (OCT). Design Cohort study. Setting Hospital Clinico San Carlos, Madrid. Patients Children between 6 and 18 years old who recovered from COVID-19 with laboratory-confirmed SARS-CoV-2 infection and historical controls were included. Interventions All patients underwent an ophthalmological examination, including macular and optic nerve OCT. Demographic data, medical history and COVID-19 symptoms were noted. Main outcome measures Peripapillary retinal nerve fibre layer thickness, macular retinal nerve fibre layer thickness, macular ganglion cell layer thickness and retinal thickness. Results 90 patients were included: 29 children who recovered from COVID-19 and 61 controls. Patients with COVID-19 presented an increase in global peripapillary retinal nerve fibre layer thickness (mean difference 7.7; 95% CI 3.4 to 12.1), temporal superior (mean difference 11.0; 95% CI 3.3 to 18.6), temporal inferior (mean difference 15.6; 95% CI 6.5 to 24.7) and nasal (mean difference 9.8; 95% CI 2.9 to 16.7) sectors. Macular retinal nerve fibre layer analysis showed decreased thickness in the nasal outer (p=0.011) and temporal inner (p=0.036) sectors in patients with COVID-19, while macular ganglion cell layer thickness increased in these sectors (p=0.001 and p=0.015, respectively). No differences in retinal thickness were noted. Conclusions Children with recent history of COVID-19 present significant changes in peripapillary and macular OCT analyses. We still have much to learn about the longer term effects on children of Covid19 infection. In this report, abnormalities in the retina of children with proven Covid19 infection are identified, though in the absence of any clear visual problems, adding the visual system to the list of systems potentially requiring long term monitoring following infection with this virus.