新型冠状病毒感染相关急性黄斑神经视网膜病变患眼临床及多模式影像特征观察

Clinical and multimodal imaging features of acute macular neuroretinopahy 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)患眼的临床和多模式影像特征。方法回顾性临床研究。2022年12月18~26日于天津市眼科医院检查确诊的COVID-19相关AMN患者8例16只眼纳入研究。其中,男性4例,女性4例;均为双眼发病。年龄(31.5±9.6)岁。发热至出现视力下降的时间为(3.75±1.04)d。患眼均行最佳矫正视力(BCVA)、眼压、眼底彩色照相、光相干断层扫描(OCT)检查。行红外眼底照相(IR)、OCT血管成像(OCTA)、荧光素眼底血管造影(FFA)检查分别为14、6、4只眼。BCVA采用国际标准对数视力表,统计时转换为最小分辨角对数(1ogMAR)视力。观察分析患者临床特征和IR、OCT、OCTA影像特征。结果悬惠眼1ogMAR BCVA 4.21±0.74;眼压(14.87±1.50)mmHg(1mmHg=0.133kPa)。眼底彩色照相检查,可见多个灰白色“花瓣样”病灶围绕黄斑中心凹排列2只眼;黄斑区未见明显异常14只眼。行IR检查的14只眼中,黄斑中心凹周围不规则弱反射病灶6只眼。OCT检查,所有患眼外核层和外丛状层可见强反射,其中伴椭圆体带损伤15只眼。行OCTA检查的6只眼,视网膜浅层毛细血管丛、深层毛细血管丛(DCP)血流密度降低,DCP为著;DCP的横断面像可见尖端指向中心凹的“楔形”强反射病变区2只眼。行FFA检查的4只眼均未见明显异常荧光。结论COVID-19相关AMN特征性表现为IR可见弱反射病灶;OCT表现为外核层和外丛状层可见强反射;OCTA表现为视网膜DCP血流密度降低。

Objective To observe the clinical and multimodal imaging characteristics of eyes with acute macular neuroretinopathy(AMN)associated with COVID-19.Methods A retrospective clinical study.From December 18 to 26,2022,16 eyes of 8 patients with AMN associated with COVID-19 were included in the study.There were 4 males and 4 females;all cases were bilateral.The age was(31.5±9.6)years old.The time from fever to decreased vision was(3.75±1.04)days.The best corrected visual acuity(BCVA),intraocular pressure,slit lamp microscopy,indirect fundus microscopy,fundus color photography,and optical coherence tomography(OCT)were performed in all patients.Infrared fundus photography(IR),OCT angiography(OCTA)and fluorescein fundus angiography(FFA)were performed in 14,6 and 4 eyes respectively.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logarithm of the minimum angle of resolution(logMAR)BCVA for statistics.The clinical data,IR,OCT and OCTA imaging features of the patients were retrospectively analyzed.Results The logMAR BCVA of AMN eyes was 4.21±0.74,intraocular pressure was(14.87±1.50)mm Hg(1 mm Hg=0.133 kPa).Fundus color photography showed that multiple gray-white petal-shaped lesions were arranged around the macular fovea in 2 eyes;no obvious abnormality was found in the macular area in 14 eyes.Of the 14 eyes examined by IR,6 eyes had irregular weak reflective lesions around the macular fovea.OCT showed strong reflex in the outer nuclear layer and outer plexiform layer of all eyes,including 15 eyes with elliptical zone injury.In 6 eyes examined by OCTA,the blood flow density of the superficial and deep capillary plexus(DCP)of retina decreased,and the blood flow density of DCP decreased significantly.The en-face image of DCP showed the wedge-shaped strong reflective lesion area with the tip pointing to the central fovea in 2 eyes.No abnormal fluorescence was observed in FFA.Conclusions The characteristic manifestation of AMN associated with COVID-19 is weak reflex focus in IR;OCT shows strong reflection in outer core layer and outer plexiform layer;OCTA showed that retinal DCP blood flow density decreased.