新型冠状病毒感染后急性黄斑神经视网膜病变临床及多模式影像特征分析  

Multimodal imaging analysis of acute macular neuroretinopathy in the coronavirus disease 2019 infection

作　　者：樊嘉雯 唐诺 宣懿 余建 王克岩 邬海翔 常青 王敏 Fan Jiawen;Tang Nuo;Xuan Yi;Yu Jian;Wang Keyan;Wu Haixiang;Chang Qing;Wang Min(Darment of Ophhamogy,Eye and ENT Hospita,Shanghai Medial Collee,Fudan Unversiy,Shanghi 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼底病杂志》2023年第9期728-734,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：上海市浦江人才计划项目(22PJ1401500)。

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)患眼的临床和多模式影像学特征。方法回顾性研究。2022年12月20日至2023年1月17日在复旦大学附属眼耳鼻喉科医院眼科就诊的COVID-19相关AMN患者29例58只眼纳人研究。所有患眼均行最佳矫正视力、眼底彩色照相、红外眼底照相(IR)、短波长自身荧光(SW-AF)、近红外自身荧光(NIR-AF)、光相干断层扫描(OCT)、OCT血管成像(OCTA)检查。所有患者均予以改善微循环口服药物治疗;其中,联合小剂量糖皮质激素口服12例。首诊后随访1~3个月,完成1个月随访共19例38只眼。结果29例患者中,男性9例18只眼,女性20例40只眼;均为双眼发病。患者年龄(29.9±9.5)(12~47)岁。发热至出现眼部症状的时间为(2.52±2.01)d。58只眼中,合并视网膜棉绒斑、视盘水肿、黄斑旁视网膜分支静脉阻塞分别为5、2、1只眼。所有患眼可见深红棕色黄斑暗区。IR检查,中心凹和旁中心凹楔形、类楔形或“花瓣样”斑片状暗区。SW-AF检查,未见明显异常39只眼;与IR一致的弱自身荧光暗区19只眼。NIR-AF检查,均可见点状或片状自身荧光暗区。OCT检查,急性期可见黄斑区自视网膜色素上皮(RPE)层垂直向上扩散的强反射病灶,呈典型“豆苗”征。OCTA检查,视网膜深层毛细血管丛(DCP)血流密度降低50只眼;横断面OCT显示外层视网膜病灶暗区范围与IR一致。初诊后1个月,病情好转18只眼(47.4%,18/38)。合并棉绒斑的5只眼中,棉绒斑消退伴视神经纤维束缺失4只眼;视盘水肿者,视盘水肿消退。所有患眼“豆苗”征消失,病灶局限,病灶区域椭圆体带和(或)嵌合体带欠连续。结论COVID-19相关AMN特征性表现为IR中心凹、旁中心凹楔形、类楔形或“花瓣样”片状暗区;OCT表现为黄斑区急性期自RPE层垂直向上扩散的强反射病灶;OCTA表现为DCP血流密度降低。Objective To observe the clinical and multimodal imaging features of eyes with acute macular neuroretinopathy(AMN)associated with the coronavirus disease 2019(COVID-19).Methods A retrospective study.From December 20,2022 to January 17,2023,a total of 29 patients(58 eyes)with COVID-19-associated AMN admitted to Department of Ophthalmology of Eye and ENT Hospital,Shanghai Medical College were included in the study.All the affected eyes underwent the best corrected visual acuity,color fundus photography,infrared fundus photography(IR),short-wavelength autofluorescence(SW-AF),near-infrared autofluorescence(NIL-AF),optical coherence tomography(OCT),and OCT angiography(OCTA).All patients were administered microcirculation-improving oral medication with 12 cases receiving adjunctive low-dose corticosteroid therapy.Follow-ups were conducted 1 to 3 months after the initial diagnosis,with a total of 19 cases(38 eyes)completing the one-month follow-up.Results Out of the 29 cases,there were 9 males(18 eyes)and 20 females(40 eyes),all of whom experienced bilateral eye involvement.The age of the patients ranged from 12 to 47 years,with an average age of(29.9±9.5)years.The time from the onset of fever to the appearance of ocular symptoms was(2.52±2.01)days.Among the 58 affected eyes,there were 5 cases with retinal cotton wool spots,2 cases with optic disc edema,and 1 case with parafoveal branch retinal vein occlusion.All affected eyes exhibited deep reddish-brown macular dark spots.IR revealed wedge-shaped,wedge-like,or"petaloid-like"dark areas involving the fovea and parafovea.SW-AF examination showed no obvious abnormality in 39 eyes.Weak autofluorescence dark area were consistent with IR in 19 eyes.NIR-AF examination showed spot-like or flaky self-fluorescent dark areas.OCT examination showed strong reflex lesions spreading vertically upward from the retinal pigment epithelium(RPE)layer in the macular area in the acute stage,showing typical"bean seedling"sign.OCTA revealed reduced blood flow density in the deep capillary p

关 键 词：新型冠状病毒感染 急性黄斑神经视网膜病变 光相干断层扫描血管成像 视网膜深层毛细血管网 棉绒斑 

分 类 号：R511[医药卫生—内科学] R774.1[医药卫生—临床医学]