新型冠状病毒感染相关视网膜病变的小型病例研究  

Small case study of retinopathy associated with novel coronavirus infection

作　　者：杨馥宇 刘胜男 陈松[1] 刘媛媛[1] 郭佳茹 周伟[1] Yang Fuyu;Liu Shengnan;Chen Song;Liu Yuanyuan;Guo Jiaru;Zhou Wei(Department of Ophthalmology,Tianjin Medical University General Hospital,Tianjin 300152,China;Department of Ophthalmology,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]天津医科大学总医院眼科,天津市300152 [2]华北理工大学附属医院眼科,河北省唐山市063000

出　　处：《国际眼科杂志》2024年第6期994-999,共6页International Eye Science

基　　金：京津冀基础研究合作专项(No.20JCZXJC00180);2022年度河北省医学科学研究课题计划(No.20220187)。

摘　　要：目的:观察新冠肺炎(COVID-19)相关视网膜病变患眼的多模式影像特征,探讨相关发病危险因素,并分析治疗和预后结果。方法:选取2022-12-13/2023-01-13在天津医科大学总医院确诊的COVID-19相关视网膜病变患者7例7眼。纳入患者均行眼底彩照、红外眼底照相(IR)、频域光相干断层扫描(SD-OCT)、眼底自发荧光(FAF)等眼科检查和血清学检查。结果:纳入患者中,视网膜中央静脉阻塞(CRVO)2例2眼表现与既往CRVO不同,患者均为青年,视网膜出血呈中心白点状的类圆形、梭形出血斑,其中1例1眼半侧视网膜静脉阻塞(HRVO)患者血管性血友病因子抗原(vWF:Ag)水平升高(161.8%),另1例1眼CRVO患者狼疮抗凝物试验(+);多发性一过性白点综合征(MEWDS)2例2眼,FAF示后极部散在圆点样高自发荧光,给予激素治疗后预后良好;急性黄斑神经视网膜病变(AMN)3例3眼,IR示黄斑旁边界清楚的低反射病灶,SD-OCT示外核层(ONL)、外界膜(ELM)高信号,EZ/IZ信号断裂,预后良好。结论:COVID-19可能引发炎症风暴,累及视网膜各层组织及血管,导致视网膜多种病变的发生,激素治疗可能有效,多预后良好,其中CRVO眼底出血可见Roth斑,狼疮抗凝物和vWF:Ag增高可能是COVID-19后易发CRVO的危险因素。AIM:To observe the clinical and multimodal imaging features of retinopathy associated with novel coronavirus disease 2019(COVID-19)infection,investigate the related risk factors,and analyze the treatment and prognosis.METHODS:A total of 7 patients(7 eyes)with clinically confirmed COVID-19-associated retinopathy in Tianjin Medical University General Hospital from December 13,2022 to January 13,2023 were included in the study.All patients underwent color fundus photography,IR,spectral-domain optical coherence tomography(SD-OCT),fundus autofluorescein(FAF)and other ophthalmic examination and serological examination.RESULTS:Among the included patients,2 cases(2 eyes)of central retinal vein occlusion(CRVO)appeared differently from previous CRVO.The hemorrhagic features of CRVO were round or fusiform shape hemorrhagic spots with white centers.One of them,the von Willebrand factor antigen(vWF:Ag)level was increased to 161.8%.The other case was positive in serologic test for lupus anticoagulant.In 2 cases(2 eyes)of multiple evanescent white dot syndrome(MEWDS),FAF showed that dots of high spontaneous fluorescence were scattered in the posterior pole.The prognosis of 2 MEWDS were good after the treatment of glucocorticoids.The 3 cases(3 eyes)of acute macular neuroretinopathy(AMN)showed reddened brown lesions in the macular area,hyporeflective lesions with clear boundaries on IR,and high signal intensity in the ONL and ELM,EZ/IZ signal fracture on SD-OCT.CONCLUSION:COVID-19 may cause inflammatory storm,involving all layers of retinal tissues and blood vessels,leading to the occurrence of various retinal lesions.Hormone therapy may be effective and the prognosis is good in most cases.Roth spot can be seen in fundus hemorrhage of CRVO,lupus anticoagulant and increased vWF:Ag may be risk factors for CRVO after COVID-19.

关 键 词：新型冠状病毒肺炎 急性黄斑神经视网膜病变 视网膜中央静脉阻塞 多发性一过性白点综合征 

分 类 号：R774.1[医药卫生—眼科]