10例新型冠状病毒感染相关眼底病变患者的眼底影像特征

The imaging features of fundus lesions associated with COVID-19 in 10 patients

目的云观察性病例系列研究。2022年12月10日至2023年1月20日于厦门大学附属厦门眼科中心检查确诊的COVID-19相关眼底病变患者10例20只眼纳人研究。患者中,男性1例,女性9例;均为双眼发病。年龄17~49岁,中位年龄26岁。确诊COVID-19至出现眼部症状的时间为0~2d;出现眼部症状至就诊的时间为1~14d。患眼均行最佳矫正视力(BCVA)、眼压、眼底彩色照相、红外眼底照相(IR)、光相干断层扫描(OCT)检查;就诊期间行血清D-二聚体检查3例。BCVA中位数0.4;眼压及眼前节检查未见明显异常。患眼中,急性黄斑神经视网膜病变(AMN)5例10只眼;Purtscher样视网膜病变(PLR)3例6只眼;视网膜中央静脉阻塞(CRVO)2例4只眼。观察分析患眼眼底影像特征。结果患眼眼底病变主要表现为AMN、急性旁中心中层黄斑病变(PAMM)、PLR、棉绒斑、视网膜出血点、视盘水肿、黄斑水肿等。AMN10只眼,黄斑区中心凹或旁中心凹黄白色“楔形”病灶,其中合并血管弓旁棉绒斑和PAMM2只眼;IR检查,AMN呈黄斑区中心凹或中心凹旁“楔形”或不规则弱反射;OCT检查,见外核层、外丛状层强反射。PAMM的OCT表现为带状内核层强反射,棉绒斑的OCT表现为视网膜神经纤维层和神经节细胞层呈丘性隆起的均匀致密强反射。PLR6只眼,后极部和(或)视盘周围可见Purtscher斑;OCT检查,与Purtscher斑对应处视网膜神经纤维层明显增厚和反射增强。其中,合并AMN4只眼;合并PAMM、黄斑水肿1只眼。CRVO4只眼中,可见玻璃体细胞、视盘水肿以及视网膜“火焰状”、点状出血和不典型棉绒斑2只眼。结论COVID-19相关眼底病变表现多样;累及视网膜多层结构,视网膜、脉络膜毛细血管层微血管受损。

Objective eTo observe the imaging features of fundus lesions associated with COVID-19.Methods A observational case series study.Twenty eyes of 10 patients with fundus lesions associated with COVID-19 at Xiamen Eye Center of Xiamen University from December 10,2022 to January 20,2023 were included in this study.There were 1 males and 9 females,aged from 17 to 49 years,with the median age of 26 years.The time of ocular symptoms after the diagnosis of COVID-19 was 0-2 days.The time from the onset of ocular symptoms to seeing a doctor was 1-14 days.All patients were examined by best-corrected visual acuity(BCVA),intraocular pressure,color fundus photography,infra-red fundus photography(IR),optical coherence tomography(OCT).Serum D-dimer examination was performed in 3 patients.The median BCVA was 0.4.There was no abnormalities in intraocular pressure and anterior segment examination.Among 20 eyes of 10 patients,there were 10 eyes of 5 patients with acute macular neuroretinopathy(AMN),6 eyes of 3 patients with Purtscher-like retinopathy(PLR),4 eyes of2 patients with central retinal vein occlusion(CRVO).The imaging features of fundus were observed and analyzed.Results Retinal lesions included AMN,paramacular central medial retinopathy(PAMM),PLR,cotton wool spots,hemorrhage,optic disc edema,macular edema.AMN was found in 10 eyes,with reddish-brown and wedge-shaped lesion in the fovea,dark area in IR and hyper reflectivity in outer nuclear layer and outer plexiform layer by OCT.The cotton wool spot showed hyper reflectivity on retinal nerve fiber layer whereas PAMM showed band-shape hyper reflectivity in inner nuclear layer by OCT.The Purtscher spot was seen at the posterior pole and/or peripapillary in 6 eyes of PLR.By OCT examination,the retinal nerve fiber layer corresponding to Purtscher flecken was significantly thickened and the reflex was enhanced.Among 6 eyes of PLR,there were 4 eyes combined with AMN,1 eye with PAMM and macular edema.In 4 eyes of CRVO,vitreous cells,optic disc edema,retinal flame,spot hemorrhage,and atypical cotton wool spots were seen in 2 eyes.ConclusionsThe manifestations of fundus lesions associated with COVID-19 are varied.The multilayer structure of retina is involved,and the microvessels of retina and choroidal capillary layer are damaged.