COVID-19感染相关视网膜中央动脉阻塞患者的眼底影像特征  

Fundus imaging features of patients with COVID-19 infection-associated central retinal artery occlusion

作　　者：雷涛 王润生 张博 崔阳阳 马腾 王小堂 王琨 LEI Tao;WANG Runsheng;ZHANG Bo;CUI Yangyang;MA Teng;WANG Xiaotang;WANG Kun(Department of Ophthalmology,Xi’an People’s Hospital(Xi’an Fourth Hospital),Xi’an 710004,Shaanxi Province,China)

机构地区：[1]西安市人民医院(西安市第四医院)眼科,陕西省西安市710004

出　　处：《眼科新进展》2023年第11期893-896,902,共5页Recent Advances in Ophthalmology

基　　金：陕西省重点研发计划项目(编号:2021SF-154);西安市科技计划项目(编号:21YXYJ0043)。

摘　　要：目的探讨COVID-19感染相关视网膜中央动脉阻塞(CRAO)患者的眼底影像特征。方法本研究为回顾性研究。选择2022年12月至2023年2月在西安市人民医院(西安市第四医院)眼科住院治疗的COVID-19感染后CRAO患者10例12眼为COVID-19组,选取近期住院治疗的非动脉炎性CRAO患者10例10眼为对照组。采用国际标准视力表检测患者最佳矫正视力(BCVA)(logMAR);对患者行瞳孔、眼球运动、裂隙灯显微镜检查、眼底彩色照相、OCT、荧光素眼底血管造影(FFA)。比较两组患者的基线特征、彩色眼底像、FFA、OCT特征。结果本组患者COVID-19感染后发生CRAO的时间为2~10 d,中位时间为3 d;两组患者发病时间差异无统计学意义(P>0.05)。COVID-19组和对照组患者的基线BCVA(logMAR)分别为1.56±0.81和2.18±0.36,治疗后两组患者BCVA(logMAR)分别为0.89±0.57和1.67±0.36,COVID-19组患者基线视力和治疗后视力均优于对照组,差异均有统计学意义(P=0.039、0.002)。COVID-19组患者彩色眼底像显示患者视盘周围棉绒斑以及FFA视盘强荧光发生率高于对照组,视网膜动脉荧光素逆行充盈发生率低于对照组,差异均有统计学意义(均为P<0.05);对照组患者的臂-视网膜循环时间与COVID-19组比较明显延长,分别为(30.81±12.90)s、(19.40±4.67)s,差异有统计学意义(P=0.017)。OCT检查显示,COVID-19组患者视网膜内层解剖分层消失的发生率低于对照组(分别为41.7%、90.0%),差异有统计学意义(P=0.026);COVID-19组与对照组患者黄斑囊样水肿的发生率(分别为50.0%、20.0%)差异无统计学意义(P=0.156);COVID-19组患者外层视网膜增厚和视盘周围神经纤维层增厚的发生率均高于对照组(分别为75.0%、30.0%,83.3%、40.0%),差异均有统计学意义(P=0.046、0.048)。结论COVID-19感染相关CRAO患者会出现眼底视盘周围棉绒斑、FFA晚期视盘强荧光、OCT视盘周围神经纤维层增厚和外层视网膜增厚等眼底影像特征�Objective To investigate the fundus imaging features of patients with central retinal artery occlusion(CRAO)after COVID-19 infection.Methods This study was a retrospective study.Ten patients(12 eyes)with COVID-19 infection-associated CRAO hospitalized in the Ophthalmology Department of Xi’an People’s Hospital(Xi’an Fourth Hospital)from December 2022 to February 2023 were selected into the COVID-19 group,and 10 patients(10 eyes)with non-arteritic CRAO hospitalized during the same period were selected into the control group.The best corrected visual acuity(BCVA)(logMAR)of the patients was measured using the international standard visual acuity chart.Pupil and eye movement examinations,slit lamp microscopy,fundus color photography,optical coherence tomography(OCT),and fluorescein fundus angiography(FFA)were performed on all patients.Baseline data,color fundus images,FFA images,and OCT images were compared between the two groups.Results The onset time of CRAO after COVID-19 infection ranged from 2 to 10 days,with a median time of 3 days.There was no significant difference in the onset time between the two groups(P>0.05).The baseline BCVA(logMAR)of patients in the COVID-19 and control groups were 1.56±0.81 and 2.18±0.36,respectively,and after treatment,the BCVA of patients in the two groups were 0.89±0.57 and 1.67±0.36,respectively.The baseline and post-treatment visual acuity of patients in the COVID-19 group were better than those in the control group(P=0.039,0.002).Color fundus images showed that in the COVID-19 group,the incidence rates of cotton-wool spots around the optic disc and FFA intense fluorescence of the optic disc were higher than those in the control group,and the incidence rate of the retrograde filling of the retinal artery fluorescein was lower than that in the control group(all P<0.05).The arm-retinal circulation time in the control group was significantly longer than that in the COVID-19 group,which was(30.81±12.90)s and(19.40±4.67)s,respectively,and the difference was statistically si

关 键 词：COVID-19 视网膜中央动脉阻塞 眼底彩色照相 荧光素眼底血管造影 OCT 

分 类 号：R774.1[医药卫生—眼科]