新型冠状病毒感染相关眼底病变患者的临床特征及疾病转归  

Clinical features and disease outcomes of patients with fundus lesions associated with novel coronavirus infection

作　　者：王沙沙 李秋明[1] 周咏薇 武佳卉 马立欣 董淑倩[1] Wang Shasha;Li Qiuming;Zhou Yongwei;Wu Jiahui;Ma Lixin;Dong Shuqian(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科、河南省眼科医院,郑州450052

出　　处：《中华实验眼科杂志》2024年第11期1028-1035,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：河南省医学科技攻关计划(省部共建重点项目)(SBGJ202102167);河南省中青年卫生健康科技创新人才培养项目(杰青人才)(YXKC2022025)。

摘　　要：目的观察新型冠状病毒感染(COVID-19)相关眼底病变患者的临床特征及疾病转归。方法采用系列病例观察研究设计,纳入2022年12月至2023年2月在郑州大学第一附属医院眼科门诊检查确诊的COVID-19相关眼底病变患者10例18眼。对患眼行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、扫描激光眼底照相(SLO)、红外眼底照相、光学相干断层扫描(OCT)、视野、微视野检查。明确诊断后根据患者意愿,6例患者口服甲钴胺、长春胺、迈之灵片治疗,4例患者口服甲泼尼龙片治疗,起始剂量每天32 mg,每5 d减4 mg,同时口服氯化钾片、碳酸钙片、奥美拉唑肠溶胶囊。根据患者的急性黄斑神经视网膜病变(AMN)诊断及治疗方案分为AMN糖皮质激素治疗组4例7眼和AMN非糖皮质激素治疗组4例8眼。随访4周,比较治疗前后BCVA、视网膜形态和结构、视网膜敏感度及注视稳定性。结果10例18眼中AMN 9例17眼,其中合并Purtscher样视网膜病变(PLR)1眼,合并急性旁中心中层黄斑病变(PAMM)1眼;多发性一过性白点综合征(MEWDS)1眼。AMN患者SLO图像可见黄斑区中心凹或旁中心凹红褐色不规则病灶,OCT图像可见黄斑中心或旁中心区外丛状层、外核层间呈斑片状强反射,相邻椭圆体带/嵌合体带有不同程度的局部断裂,反射信号紊乱。患眼治疗后4周BCVA较治疗前提升,差异有统计学意义(Z=-2.823,P<0.05)。患眼治疗后4周视网膜敏感度为(26.57±2.24)dB,较治疗前的(24.17±2.73)dB显著提升,差异有统计学意义(t=-11.329,P<0.001)。AMN糖皮质激素治疗组和AMN非糖皮质激素治疗组治疗前和治疗后4周BCVA差值和视网膜敏感度差值比较,差异均无统计学意义(Z=-0.986,P>0.05;t=-1.656,P>0.05)。结论COVID-19相关眼底病变主要表现为AMN、PAMM、PLR、MEWDS等;OCT、微视野等辅助检查可以协助诊断疾病;该疾病引起的视力损害及眼底结构改变在治疗后4周逐渐好转。Objective To observe the clinical features and disease outcomes of patients with fundus lesions associated with novel coronavirus infection(COVID-19).Methods A case series observational study was conducted.Eighteen eyes of 10 patients with COVID-19 related fundus lesions diagnosed in the First Affiliated Hospital of Zhengzhou University from December 2022 to February 2023 were included.The affected eyes were examined by best corrected visual acuity(BCVA),intraocular pressure,slit lamp microscopy,scanning laser fundus photography(SLO),infrared fundus photography,optical coherence tomography(OCT),visual field and microperimetry.After the diagnosis was confirmed,according to the patients'willingness,6 patients were treated with mecobalamin,vinblastine,and Aescuven forte orally.The other 4 patients were treated with glucocorticoid and methylprednisolone tablets orally with an initial dose of 32 mg/d,and the dose was reduced by 4 mg every 5 days,and potassium chloride tablets,calcium carbonate tablets,and omeprazole enteric-coated capsules were taken orally.According to the diagnosis and treatment of acute macular neuroretinopathy(AMN),the patients were divided into glucocorticoid treatment group(4 cases,7 eyes)and non-glucocorticoid treatment group(4 cases,8 eyes).The patients were followed up for 4 weeks.The BCVA,retinal morphology and structure,retinal sensitivity and fixation stability were compared before and after treatment.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University(No.2022-KY-1482-002).Written informed consent was obtained from each subject.Results Among the enrolled 10 cases(18 eyes),there were 9 cases(17 eyes)of AMN,including 1 eye with Purtscher-like retinopathy(PLR),1 eye with acute para-central medial maculopathy(PAMM),and 1 eye with multiple transient white dot syndrome(MEWDS).The SLO images of AMN patients showed redbrown irregular lesions in the fovea or parafovea of the macular area.T

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 多发性一过性白点综合征 光相干断层扫描 微视野 

分 类 号：R511[医药卫生—内科学] R747.9[医药卫生—临床医学]