A Case of Branch Retinal Arteriole Occlusion and Paracentral Acute Middle Maculopathy after COVID-19 Infection

Introduction: The aim of this study was to report a case of segmental deep capillary plexus ischemic injury after COVID-19 infection in a vaccinated otherwise healthy male. Case Presentation: A healthy 38-year-old male presented with a complaint of not being able to see above his fixation point in the left eye. He had developed a positive scotoma 2 weeks after a COVID-19 infection. Examination showed a branch retinal arteriole occlusion in the inferotemporal quadrant with an area of subtle arcuate retinal whitening inferior to the fovea. Systemic workup was unremarkable. His vision remained 20/20, with a persistent scotoma over 2 months. Severe thinning of the inner nuclear layer and marked attenuation of the outer plexiform layer in an arcuate segment inferior to the fovea were detected with optical coherence tomography (OCT). OCTA revealed a flow void in the deep capillary plexus inferior to the fovea and cessation of the blood flow distal to the occluded retinal arteriole. Conclusion: This case highlights the deep capillary plexus's unique vulnerability to COVID-19-related occlusion, likely due to its high autoregulatory demand and dense vascular architecture. It emphasizes the need for further investigation into retinal microvascular complications of the disease.