新型冠状病毒感染相关视网膜疾病的多模式影像特征分析  

Multimodal imaging characteristics of retinal diseases associated with COVID-19

作　　者：杨凯转[1] 闫淑[1] 邵玲[1] 李琰[1] 刘钰[1] 杜敏[1] 陈梦平[1] Yang Kaizhuan;Yan Shu;Shao Ling;Li Yan;Liu Yu;Du Min;Chen Mengping(Department of Ophthalmology,The Second People's Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州市第二人民医院眼科,郑州450000

出　　处：《中华眼底病杂志》2023年第3期194-198,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察新型冠状病毒感染(COVID-19)相关视网膜疾病的多模式影像特征。方法回顾性病例研究。2022年12月于郑州市第二人民医院眼科就诊的COVID-19相关视网膜疾病患者16例30只眼纳入研究。其中,男性5例,女性11例;年龄(26.69±9.88)岁;双眼、单眼发病分别为14、2例。确诊COVID-19至出现眼部症状的时间为(2.63±0.89)d。患眼均行最佳矫正视力(BCVA)、眼底彩色照相(FP)、红外眼底照相(IR)、光相干断层扫描(OCT)检查。行荧光素眼底血管造影(FFA)检查2例4只眼。患眼中,急性黄斑神经视网膜病变(AMN)20只眼,其中合并棉绒斑6只眼;Purtscher样视网膜病变(PLR)10只眼。BCVA0.1~1.0。眼前节检查均未见明显异常。观察分析患眼FP、IR、OCT影像特征。结果AMN20只眼中,黄斑中心或旁中心区不规则“地图状”微褐色病灶14只眼;FP检查未见明显异常6只眼;IR检查,患眼均可见黄斑中心或旁中心区不规则“地图状”弱反射;OCT检查,患眼均可见外核层中强反射伴椭圆体带和嵌合体带不连续;行FFA检查的2只眼,未见明显异常荧光。PLR10只眼,后极部和(或)视盘周围可见棉绒斑、视网膜出血,周边视网膜大致正常,其中可见Purtscher斑5只眼、黄斑水肿4只眼;OCT检查可见神经上皮层间强反射信号,神经上皮层间水肿6只眼;行FFA检查的2只眼,视网膜静脉管壁荧光素渗漏,后极部及视盘周围视网膜前小动脉闭塞呈斑片状弱荧光,下方出血遮蔽荧光。结论COVID-19相关AMN的IR可显示病灶的轮廓,OCT显示病灶在外层视网膜;COVID-19相关PLR的FP显示病变通常在后极部和(或)视盘周围,OCT显示神经上皮层水肿。Objective To observe the multimodal imaging features of retinal diseases associated with COVID-19.Methods A retrospective case study.Sixteen patients(30 eyes)of retinal diseases associated with COVID-19 admitted to the Ophthalmology Department of the Second People's Hospital of Zhengzhou in December 2022 were included in the study.There were 5 males and 11 females,with the mean age of(26.69±9.88)years;14 patients were bilateral and 2 patients were unilateral.The time of ocular symptoms after the diagnosis of COVID-19 was(2.63±0.89)days.All patients underwent the examinations of best corrtected visual acuity(BCVA),fundus color photography(FP),infrared fundus photography(IR),optical coherence tomography(OCT).Fluorescein fundus angiography(FFA)was performed in 2 patients(4 eyes).There were 20 eyes with acute macular neuroretinopathy(AMN),including 6 eyes with cotton wool spots;10 eyes with Purtscher-like retinopathy(PLR).The BCVA of the patients was 0.1-1.0.No obvious abnormality was found in anterior segment examination.The features of FP,IR and OCT were analyzed retrospectively.Results In 20 eyes of AMN,irregular reddish brown lesions in the central or paracentral area of the macula in 14 eyes;FP showed no obvious abnormality in 6 eyes;IR showed irregular map like low reflection in the central or paracentral area of macular in all eyes;OCT showed hyperreflectivity in outer plexiform layer and outer nuclear layer,hyporeflectivity in the ellipsoid zone and photoreceptor layers in alleyes;no abnormalfluorecence was observed in 2 eyes examined by FFA.In 10 eyes with PLR,cotton wool spots and retinal hemorrhage were observed in the posterior pole and/or peripapillary area,and the peripheral retina was generally normal,Purtscher spot was found in 5 eyes and macular edema in 4 eyes;OCT showed strong reflex signal in neuroepithelial layers,edema in neuroepithelial layers in 6 eyes;in the 2 eyes examined by FFA,fluorescein leakage from the retinal vein wall was observed,the posterior pole and peripapillary area retinal a

关 键 词：新型冠状病毒感染 急性黄斑神经视网膜病变 Purtscher样视网膜病变 多模式影像 

分 类 号：R739.7[医药卫生—肿瘤]