Endothelial Glycocalyx Anomalies and Ocular Manifestations in Patients with Post-Acute COVID-19

<b>Objectives</b>: To report ophthalmological and microvascular findings in patients with post-acute COVID-19. <b>Methods</b>: In this prospective, monocentric cohort study, we included patients with post-acute COVID-19 who presented with ophthalmological symptoms. All patients underwent indocyanine green angiography (ICGA), OCT, OCT-angiography, adaptive optics, and GlycoCheck assessments. <b>Results:</b> We included 44 patients, predominantly female (81.8%), with a mean age of 47.5 ± 11.5 years. Key ICGA findings revealed hyperreflective dots in 32 eyes (36.4%) and hemangioma-like lesions in 7 eyes (8.0%). Capillary non-perfusion in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was observed in 42 eyes (47.7%) and 21 eyes (23.9%), respectively. Eyes with hyperreflective dots exhibited a lower perfused boundary region (PBR), while those with superficial punctate keratitis showed a higher PBR (<i>p</i> = 0.02 and <i>p</i> = 0.002, respectively). Eyes with capillary non-perfusion in the SCP displayed lower capillary densities (CD4, CD5, and CD4-6; <i>p</i> = 0.001, 0.03, and 0.03, respectively), and eyes with non-perfusion in the DCP had lower CD4 (<i>p</i> = 0.03). A negative correlation was identified between capillary density and the wall-to-lumen ratio. <b>Conclusions:</b> Patients with post-acute COVID-19 demonstrate both retinal and choroidal vascular anomalies. Ocular pathology was associated with reduced capillary density. These injuries appear to stem more from microvascular disruptions than from persistent glycocalyx abnormalities.