新型冠状病毒感染相关急性黄斑神经视网膜病变的临床及眼底影像特征

Clinical and fundus imaging features of acute macular neuroretinopathy associated with COVID-19

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)的临床特征及眼底影像特征。方法法回顾性病例观察研究。2022年12月至2023年2月在成都爱迪眼科医院确诊为COVID-19相关AMN的18例患者32只眼纳人研究。所有患者在眼部发病前1~5d均有发热病史,且严重急性呼吸综合征冠状病毒2型抗原检测阳性。所有患者均行最佳矫正视力(BCVA)、眼底彩色照相、激光扫描检眼镜(SLO)、眼底自身荧光(AF)、红外眼底照相(IR)及光相干断层扫描(OCT)检查;同时行OCT血管成像(OCTA)、视野及多焦视网膜电图(mf-ERG)检查分别为6例11只眼、3例6只眼、1例2只眼。随访时间8~10周。观察分析患者的临床特征和眼底影像特征。结果18例32只眼中,男性6例12只眼,女性12例20只眼;年龄(28.00±5.86)(15~36)岁。双眼、单眼发病分别为14、4例。出现眼部症状到就诊时间为1d~8周;其中,发病3d内就诊6例10只眼,发病超过3d就诊12例22只眼。患眼BCVA0.80±0.29。眼底彩色照相及SLO检查,仅2例4只眼表现为黄斑区片状或“花瓣样”暗红色病灶,其余患者均未见明显异常改变。眼底AF检查,均未见明显异常AF。IR检查,发病3d内就诊的6例10只眼未见明显异常改变;发病超过3d就诊的12例22只眼黄斑区出现不规则的弱反射病灶。OCT检查,所有患眼均可见黄斑中心凹或旁中心凹区的外丛状层(OPL)、外核层(ONL)边缘模糊的条带状或斑片状强反射,并波及椭圆体带及嵌合体带。行OCTA检查的6例11只眼,其病灶区脉络膜毛细血管层血流密度降低。行视野检查的3例6只眼,表现为生理盲点稍扩大。行mf-ERG的1例2只眼,表现为黄斑中心振幅呈凹陷型降低。2周内,所有患眼OPL及ONL强反射病灶快速消退,而椭圆体带的连续性则恢复缓慢,嵌合体带的中断可持续10周以上。结论COVID-19相关AMN多为年轻女性;IR表现为病变区呈不规则弱反射;OCT表现为OPL、ONL呈强反射;OCTA表现为病灶区脉络膜毛细血管层血流密度降低。

Objective eTo observe the clinical and fundus imaging features of acute macular neuroretinopathy(AMN)associated with COVID-19.Methods A retrospective case study.A total of 32 eyes of 18 patients diagnosed of AMN associated with COVID-19 at Chengdu Aidi Eye Hospital from December 2022 to February 2023 were included.All patients had a history of fever 1 to 5 days prior to ocular onset and tested positive for SARS CoV-2 antigen.All patients were examined by best-corrected visual acuity(BCVA),color fundus photography,scanning laser ophthalmoscope(SLO),infrared fundus photography(IR),and optical coherence tomography(OCT);OCT angiography,visual field and multifocal electroretinogram(mf-ERG)were performed in 6 patients(11 eyes),3 patients(6 eyes)and 1 patient(2 eyes),respectively.Follow-up time was 8-10 weeks.The clinical and fundus imaging features were observed and analyzed.Results There were 6 males(12 eyes)and 12 females(20 eyes),aged from 15 to 36 years,with the mean age of(28.00±5.86)years.Fourteen patients were bilateral and 4 patients were unilateral.The time from the onset of eye symptoms to seeing a doctor was ranged from 1 day to 8 weeks.Among them,6 patients(10 eyes)visited the doctor within 3 days of onset,while 12 patients(22 eyes)visited the doctor after 3 days of onset.The BCVA was 0.80±0.29.Fundus color photography and SLO examination showed that only 2 patients(4 eyes)showed sheet or petal-like dark red lesions in the macular area,and no obvious abnormal changes were observed in other patients.No obvious abnormalities were found in AF examination of all patients.IR examination showed no significant abnormality in 6 cases which came to hospital within 3 days after the onset,but irregular hyporeflective dark shadow lesions in the macular region of patients with more than 3-day course of disease was observed.OCT examinations of all eyes showed hyperreflective band or patchy lesion on the outer plexiform layer(OPL)and outer nuclear layer(ONL)and affect the ellipsoid zone(EZ)and interdigitation zone(IZ).In 11 eyes of 6 patients undergoing OCTA examination,the blood flow density of the choroidal capillary layer in the focal area decreased.In 6 eyes of 3 patients who underwent visual field examination,the physiologic scotoma was slightly enlarged.One patient(2 eyes)receiving mf-ERG showed a concave reduction in macular center amplitude.The hyperreflective band lesion on OPL and ONL disappear rapidly within 2 weeks,while the continuity of EZ recovered slowly,and the disruption of IZ kept existing for more than 10 weeks.Conclusions Most AMN associated with COVID-19 are young women;IR showed irregular weak reflex in the lesion area.OCT showed strong OPL and ONL reflection.OCTA was characterized by decreased blood flow density in the choroidal capillary layer of the focal area.