新型冠状病毒感染相关急性黄斑神经视网膜病变的临床特征  

Clinical features of acute macular neuroretinopathy associated with COVID-19

作　　者：钟育晟 程湧[1] 赵明威[1] 钱彤[1] Zhong Yusheng;Cheng Yong;Zhao Mingwei;Qian Tong(Peking University People's Hospital,Eye Diseases and Optometry Institute,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases,Department of Ophthalmology&Clinical Centre of Optometry,College of Optometry,Peking University Health Science Center,Beijing 100044,China)

机构地区：[1]北京大学人民医院眼病与视光医学研究所、视网膜脉络膜诊治研究北京市重点实验室、眼科与眼视光中心、北京大学医学部眼视光学院,北京100044

出　　处：《中华眼底病杂志》2023年第3期218-222,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)相关急性黄斑神经视网膜病变(AMN)的临床特征。方法回回顾性病例系列研究。2022年12月5日至2023年1月5日于北京大学人民医院眼科检查确诊的COVID-19相关AMN患者8例12只眼纳入研究。其中,男性2例4只眼,女性6例8只眼;年龄(29.38±8.60)岁。所有患者均行最佳矫正视力(BCVA)、频域光相干断层扫描(OCT)、红外眼底照相(IR)检查。明确诊断后给予患者局部扩血管、抗炎及全身改善循环、营养神经等对症治疗。随访时间21~30d。回顾分析患眼临床表现和OCT、IR影像特征及治疗结果。结果8例患者确诊COVID-19至出现眼部症状的时间为(3.00±0.93)d。12只眼中,主诉旁中心暗点6只眼,其中伴视力下降2只眼;眼前黑影6只眼,其中伴视力下降2只眼。初诊时BCVA低于0.05者2只眼,0.4~0.6者2只眼,0.8~1.0者8只眼。末次随访时,视觉症状改善7只眼;无明显改善5只眼。所有患眼眼底彩色照相可见黄斑区红褐色病变。频域OCT检查可见黄斑部视网膜外丛状层(OPL)局部增宽呈强反射,外核层(ONL)斑块样强反射灶,相邻外界膜、椭圆体带/嵌合体带(EZ/IZ)均有不同程度的局部断裂,其中2只眼相邻视网膜色素上皮层局部反射减弱。对应结构OCT的OPL、ONL强反射部位,横断面(en-face)OCT可清晰观察到病灶范围呈强反射;对应EZ/IZ结构不完整部位,en-face OCT可清晰观察到病灶范围呈弱反射。IR示黄斑中心凹处数个边界清楚、弱反射病灶,尖端指向中心凹。结论COVID-19相关AMN好发于年轻女性;AMN的OCT表现为特征性OPL和ONL强反射灶,en-face OCT可更清晰地观察到不同层面的病灶;IR表现为弱反射病灶。Objective To evaluate the clinical features of acute macular neuroretinopathy(AMN)associated with COVID-19.Methods A retrospective case series studies.A total of 12 eyes of 8 patients diagnosed of AMN associated with COVID-19 at Peking University People's Hospital from December 5,2022 to January 5,2023 were included.Of the 8 patients,2 were male(4 eyes)and 6 were female(8 eyes),with an average age of(29.38±8.60)years.All patients underwent best-corrected visual acuity(BCVA),spectral-domain optical coherence tomography(OCT),and infra-red fundus photography(IR).After definite diagnosis,the patients were given symptomatic treatment such as local vasodilation,anti-inflammatory and systemic circulation improvement and nutritional nerve.Follow-up time was 21-30 days weeks.Clinical manifestations,OCT and IR image characteristics,and treatment outcomes were retrospectively analyzed.Results The time from diagnosis of COVID-19 to the onset of ocular symptoms was(3.00±0.93)days.Among 12 eyes,6 had complaints of paracentral scotoma,with 2 of them accompanied by visual acuity loss;and 6 had complaints of dark shadows in the vision,with 2 of them accompanied by visual acuity loss.At the initial examination,2 eyes had a BCVA of less than 0.05,2 eyes had a BCVA between 0.4 and 0.6,and 8 eyes had a BCVA between 0.8 and 1.0.At the last follow-up,visual symptoms improved in 7 eyes and remained unchanged in 5 eyes.Fundus color photography showed reddish-brown lesions in the macular area.Spectral-domain OCT revealed localized thickening and strong reflection of the outer plexiform layer(OPL)in the macular area,patchy strong reflections in the outer nuclear layer(ONL),and varying degrees of local discontinuity in the adjacent external limiting membrane,ellipsoid zone/interdigitation zone(EZ/IZ),with reduced local reflection in the adjacent retinal pigment epithelium layer in 2 eyes.The strong reflection area of the ONL on corresponding structural OCT was observed more clearly as a lesion range with strong reflection on en-face OCT.T

关 键 词：新型冠状病毒感染 急性黄斑神经视网膜病变 多模式影像 

分 类 号：R774.1[医药卫生—眼科]