{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T09:52:26Z","timestamp":1790502746564,"version":"4.1.0"},"reference-count":50,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Imaging"],"abstract":"<jats:p>Recent evidence suggests that SARS-CoV-2 may induce subtle anatomical changes in the retina, detectable through advanced imaging techniques. This retrospective case\u2013control study utilized optical coherence tomography (OCT) to assess medium-term retinal alterations in 55 healthcare workers, including 25 individuals with PCR-confirmed COVID-19 and 30 non-COVID-19 controls, all of whom had worked in COVID-19 clinical settings. Comprehensive ophthalmological examinations, including OCT imaging, were conducted six months after infection. The analysis considered demographic variables, comorbidities, COVID-19 severity, risk factors, and treatments received. Central macular thickness (CMT) was significantly increased in the post-COVID-19 group (p &lt; 0.05), with a weak but statistically significant positive correlation between CMT and disease severity (r = 0.245, p &lt; 0.05), suggesting potential post-inflammatory retinal responses. No significant differences were observed in retinal nerve fiber layer (RNFL) or ganglion cell complex (GCL + IPL) thickness. However, mild negative trends in inferior RNFL and average GCL+IPL thickness may indicate early neurodegenerative changes. Notably, patients with comorbidities exhibited a significant reduction in superior and inferior RNFL thickness, pointing to possible long-term neurovascular impairment. These findings underscore the value of OCT imaging in identifying subclinical retinal alterations following COVID-19 and highlight the need for continued surveillance in recovered patients, particularly those with pre-existing systemic conditions.<\/jats:p>","DOI":"10.3390\/jimaging11060195","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T07:44:23Z","timestamp":1749714263000},"page":"195","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Optical Coherence Tomography (OCT) Findings in Post-COVID-19 Healthcare Workers"],"prefix":"10.3390","volume":"11","author":[{"given":"Sanela Sanja","family":"Burgi\u0107","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Eye Clinic, University Clinical Center of Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Resan","sequence":"additional","affiliation":[{"name":"Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, 11000 Belgrade, Serbia"},{"name":"Eye Clinic, Military Medical Academy in Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Physics, Faculty of Scienses, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0931-560X","authenticated-orcid":false,"given":"Milka","family":"Mavija","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Eye Clinic, University Clinical Center of Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sa\u0161a","family":"Smoljanovi\u0107 Sko\u010di\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia"},{"name":"Eye Clinic, King Khalid Hail Hospital, Hail 55421, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0326-2562","authenticated-orcid":false,"given":"Sanja","family":"Grgi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Neurology Clinic, University Clinical Center of Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daliborka","family":"Tadi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Neurology Clinic, University Clinical Center of Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1987-6232","authenticated-orcid":false,"given":"Bojan","family":"Pajic","sequence":"additional","affiliation":[{"name":"Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Physics, Faculty of Scienses, University of Novi Sad, 21000 Novi Sad, Serbia"},{"name":"Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1211 Geneva, Switzerland"},{"name":"Experimental Ophthalmology, University of Geneva, 1211 Geneva, Switzerland"},{"name":"Eye Clinic ORASIS, Swiss Eye Research Foundation, 4153 Reinach, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bansal, A., Trieu, M.-C., Eriksson, E.M., Zhou, F., McVernon, J., Brokstad, K.A., and Cox, R.J. (2025). SARS-CoV-2 Infection Rates and Associated Risk Factors in Healthcare Workers: Systematic Review and Meta-Analysis. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-89472-5"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chung, M.K., Karnik, S., Saef, J., Bergmann, C., Barnard, J., Lederman, M.M., Tilton, J., Cheng, F., Harding, C.V., and Young, J.B. (2020). SARS-CoV-2 and ACE2: The biology and clinical data settling the ARB and ACEI controversy. EBioMedicine, 58.","DOI":"10.1016\/j.ebiom.2020.102907"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1080\/02713680490517944","article-title":"Identification of angiotensin converting enzyme 2 in the rodent retina","volume":"29","author":"Tikellis","year":"2004","journal-title":"Curr. Eye Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1089\/jop.2008.0081","article-title":"Activities of angiotensin-converting enzymes ACE1 and ACE2 and inhibition by bioactive peptides in porcine ocular tissues","volume":"25","author":"Luhtala","year":"2009","journal-title":"J. Ocul. Pharmacol. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3301","DOI":"10.1167\/iovs.06-1024","article-title":"Angiotensin II and its receptor subtypes in the human retina","volume":"48","author":"Senanayake","year":"2007","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1007\/s00347-020-01160-z","article-title":"Kann SARS-CoV-2 das Auge infizieren?\u2014Ein \u00dcberblick\u00fcber den Rezeptorstatus in okularemGewebe","volume":"117","author":"Schnichels","year":"2020","journal-title":"Ophthalmologe"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1080\/09273948.2020.1799037","article-title":"SARS-CoV-2 Targeting the Retina: Host\u2013virus Interaction and Possible Mechanisms of Viral Tropism","volume":"28","author":"Raony","year":"2020","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1080\/09273948.2020.1770301","article-title":"Detection of SARS-CoV-2 in human retinal biopsies of deceased COVID-19 patients","volume":"28","author":"Casagrande","year":"2020","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40662-023-00329-2","article-title":"Microglia Activation and Neuronal Alterations in Retinas from COVID-19 Patients: Correlation with Clinical Parameters","volume":"10","author":"Noailles","year":"2023","journal-title":"Eye Vis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s40123-020-00299-x","article-title":"Does COVID-19 Involve the Retina?","volume":"9","author":"Karampelas","year":"2020","journal-title":"Ophthalmol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2352","DOI":"10.1038\/s41433-020-1069-8","article-title":"Paracentral acute middle maculopathy and acute macular neuroretinopathy following SARS-CoV-2 infection","volume":"34","author":"Virgo","year":"2020","journal-title":"Eye"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e00867","DOI":"10.1016\/j.idcr.2020.e00867","article-title":"Unique case of central retinal artery occlusion secondary to COVID-19 disease","volume":"21","author":"Acharya","year":"2020","journal-title":"IDCases"},{"key":"ref_13","first-page":"NP168","article-title":"Papillophlebitis in a COVID-19 patient: Inflammation and hypercoagulable state","volume":"32","year":"2020","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.4103\/ijo.IJO_2380_20","article-title":"Retinal vein occlusion in COVID-19: A novel entity","volume":"68","author":"Sheth","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"108280","DOI":"10.1016\/j.diabres.2020.108280","article-title":"Retinal outcomes of COVID-19: Possible role of CD147 and cytokine storm in infected patients with diabetes mellitus","volume":"165","author":"Raony","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Savastano, A., Crincoli, E., Savastano, M.C., Younis, S., Gambini, G., De Vico, U., Cozzupoli, G.M., Culiersi, C., and Rizzo, S. (2020). Gemelli against COVID-19 post-acute care study group peripapillary retinal vascular involvement in early post-COVID-19 patients. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092895"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/S0140-6736(20)31014-X","article-title":"Retinal findings in patients with COVID-19","volume":"395","author":"Marinho","year":"2020","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/bjophthalmol-2020-317576","article-title":"Retinal findings in hospitalised patients with severe COVID-19","volume":"106","author":"Pereira","year":"2022","journal-title":"Br. J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jcjo.2020.11.006","article-title":"Optical coherence tomography angiography analysis of the retina in patients recovered from COVID-19: A case-control study","volume":"56","author":"Abrishami","year":"2021","journal-title":"Can. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jcjo.2021.06.019","article-title":"SD-OCT assessment of macular and optic nerve alterations in patients recovered from COVID-19","volume":"57","author":"Yildiz","year":"2022","journal-title":"Can. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kaim, M., K\u0131r, M.B., Uzun, F., and Findik, H. (2025). Evaluation of Retinal and Optic Nerve Parameters in Recovered COVID-19 Patients: Potential Neurodegenerative Impact on the Ganglion Cell Layer. Diagnostics, 15.","DOI":"10.3390\/diagnostics15101195"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lyons, C.E., Alhalel, J., Busza, A., Suen, E., Gill, N., Decker, N., Suchy, S., Orban, Z., Jimenez, M., and Perez Giraldo, G. (2025). Non-Hospitalized Long COVID Patients Exhibit Reduced Retinal Capillary Perfusion: A Prospective Cohort Study. J. Imaging, 11.","DOI":"10.3390\/jimaging11020062"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kalaw, F.G.P., Warter, A., Cavichini, M., Knight, D., Li, A., Deussen, D., Galang, C., Heinke, A., Mendoza, V., and Borooah, S. (2023). Retinal tissue and microvasculature loss in COVID-19 infection. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-31835-x"},{"key":"ref_24","unstructured":"World Health Organization (2020). Clinical Management of COVID-19: Interim Guidance, WHO. Available online: https:\/\/iris.who.int\/handle\/10665\/332196."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1007\/s00417-020-04790-w","article-title":"Risk of SARS-CoV-2 transmission to medical staff and patients from an exposure to a COVID-19-positive ophthalmologist","volume":"258","author":"Saban","year":"2020","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/S0140-6736(20)30627-9","article-title":"COVID-19 and Italy: What next?","volume":"395","author":"Remuzzi","year":"2020","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1056\/NEJMc2005696","article-title":"Death from Covid-19 of 23 health care workers in China","volume":"382","author":"Zhan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1056\/NEJMc2001737","article-title":"SARS-CoV-2 viral load in upper respiratory specimens of infected patients","volume":"382","author":"Zou","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_29","first-page":"32","article-title":"Ocular manifestations of SARS-CoV-2: Literaturereview","volume":"96","year":"2020","journal-title":"Arch. Soc. Esp. Oftalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"95","DOI":"10.51329\/mehdiophthal1427","article-title":"Posterior segment manifestations and imaging features post-COVID-19","volume":"10","author":"Sanjay","year":"2021","journal-title":"Med. Hypothesis Discov. Innov. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1002\/jmv.25725","article-title":"Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection","volume":"92","author":"Xia","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e951","DOI":"10.1111\/aos.14472","article-title":"Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: A cross-sectional study","volume":"98","author":"Chen","year":"2020","journal-title":"Acta Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Wei, J., Chen, X., Wang, L., Wang, Z., Li, J., and Wang, Z. (2024). A Cross-Sectional Study of Fundus Lesion Characteristics in Patients with Acute Visual Impairment Caused by COVID-19 Infection. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-79509-6"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/joim.13156","article-title":"COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease?","volume":"289","author":"Landecho","year":"2021","journal-title":"J. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1097\/IJG.0000000000002204","article-title":"Effects of COVID-19 on Retinal and Choroidal Thickness by Optical Coherence Tomography","volume":"32","author":"Sumer","year":"2023","journal-title":"J. Glaucoma"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Noor, M., McGrath, O., Drira, I., and Aslam, T. (2023). Retinal Microvasculature Image Analysis Using Optical Coherence Tomography Angiography in Patients with Post-COVID-19 Syndrome. J. Imaging, 9.","DOI":"10.3390\/jimaging9110234"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/jmv.26290","article-title":"Optic nerve analysis in COVID-19 patients","volume":"93","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.jcjo.2022.06.016","article-title":"Assessment of the optic nerve, macular, and retinal vascular effects of COVID-19","volume":"58","author":"Ugurlu","year":"2023","journal-title":"Can. J. Ophthalmol."},{"key":"ref_40","first-page":"102","article-title":"Retinal nerve fiber layer thickness and peripapillary vasculature of post-COVID-19 patients with and without olfactory\/gustatory dysfunction symptoms","volume":"14","year":"2023","journal-title":"Taiwan J. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3815","DOI":"10.1007\/s10792-021-01952-5","article-title":"COVID-19: More than a respiratory virus, an optical coherence tomography study","volume":"41","author":"Seker","year":"2021","journal-title":"Int. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1016\/j.ophtha.2018.03.026","article-title":"Systemic and Ocular Determinants of Peripapillary Retinal Nerve Fiber Layer Thickness Measurements in the European Eye Epidemiology (E3) Population","volume":"125","author":"Mauschitz","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1038\/s41433-020-0775-6","article-title":"Analysis of central macular thickness and choroidal thickness changes in patients with cardiovascular risk factors","volume":"34","author":"Aydin","year":"2020","journal-title":"Eye"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Talebnejad, M.R., Badie, M.R., Shahriari, H., and Nowroozzadeh, M.H. (2025). Analysis of Retinal Sublayers in Patients with Systemic COVID-19 Illness with Varying Degrees of Severity. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-87446-1"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2000688","DOI":"10.1183\/13993003.00688-2020","article-title":"ACE-2 expression in the small airway epithelia of smokers and COPD patients: Implications for COVID-19","volume":"55","author":"Leung","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4274\/tjo.galenos.2018.80588","article-title":"The Effect of Smoking on Macular, Choroidal, and Retina Nerve Fiber Layer Thickness","volume":"49","author":"Teberik","year":"2019","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"173454","DOI":"10.1016\/j.ejphar.2020.173454","article-title":"Molecular effects and retinopathy induced by hydroxychloroquine during SARS-CoV-2 therapy","volume":"886","author":"Paniri","year":"2020","journal-title":"Eur. J. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1038\/eye.2016.298","article-title":"Hydroxychloroquine retinopathy","volume":"31","author":"Yusuf","year":"2017","journal-title":"Eye"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1097\/IAE.0000000000001690","article-title":"Twenty-four month follow-up of tocilizumab therapy for refractory uveitis-related macular edema","volume":"38","author":"Mesquida","year":"2018","journal-title":"Retina"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1007\/s00417-020-05070-3","article-title":"Retinal capillary involvement in early post-COVID-19 patients: A healthy controlled study","volume":"259","author":"Savastano","year":"2021","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."}],"container-title":["Journal of Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2313-433X\/11\/6\/195\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:50:48Z","timestamp":1760032248000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2313-433X\/11\/6\/195"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,12]]},"references-count":50,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jimaging11060195"],"URL":"https:\/\/doi.org\/10.3390\/jimaging11060195","relation":{},"ISSN":["2313-433X"],"issn-type":[{"value":"2313-433X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,12]]}}}