Unilateral Endotheliitis And Progressed Cataract After Systemic Covid-19 Infection

To report a case of unilateral endotheliitis and progressed white cataract after systemic COVID-19 infection and how we approached the case.

Naval and Veterans Hospital, Athens, Greece, AKTINA Center, Athens, Greece

A 54-year-old male patient presented with reduced visual acuity in his right eye (OD) that deteriorated rapidly after systemic COVID-19 infection to the level of Light Percetion. The patient reported preexisting unilateral cataract in the same eye that progressed rapidly after COVID-19 infection. Furthermore, he mentioned some irritation in OD that developed during the COVID-19 infection. Slit lamp evaluation revealed numerous fine keratic precipitates dispersed almost evenly especially on the inferior half of the corneal endothelium together with very progressed white cataract only in OD. No clinical findings were evident in the other eye (OS). Fundus examination was impossible to be performed.

Specular microscopy revealed significant irregularities of the endothelial cells only in OD with reduced hexagonality, increased size, decreased density and irregular shape. Corneal pachymetry was symmetrical between the two eyes (505μm). The patient underwent standard phacoemulsification. Immediately after extracting the cataract, signs of hyalitis were already visible under the surgical microscope. The patient received a subconjunctival injection of betamethasone immediately after phacoemulsification, followed by Cyclopentolate and Atropine drops for 15 days. No severe inflammation was observed postoperatively. The condition of the corneal endothelium remained unaltered for 3 months after the operation. 

Unilateral endotheliitis may develop after systemic COVID-19 infection. It cannot be confirmed whether it is related to progressed ipsilateral cataract.