摘要
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)患眼的多模式影像特征。方法回顾性病例研究。2022年12月8~20日于邯郸市眼科医院(邯郸市第三医院)检查确诊的COVID-19相关AMN患者26例52只眼纳入研究。其中,男性8例,女性18例;年龄(33.8±8.1)岁;均为双眼发病。确诊COVID-19至出现视力下降的时间为3~6d。患眼均行最佳矫正视力(BCVA)、眼底彩色照相、红外光眼底照相(IR)、眼底自身荧光(AF)、光相干断层扫描(OCT)检查;行荧光素眼底血管造影(FFA)联合吲哚青绿血管造影(ICGA)、视野检查分别为12、18只眼。回顾分析患眼多模式影像特征。结果患眼BCVA为0.25~1.0。所有患眼可见黄斑区类圆形或斑点状灰白色病灶。IR检查,黄斑区不规则“地图状”弱反射;眼底AF检查,病变相关区域斑点状荧光增强3只眼。行FFA联合ICGA检查的12只眼中,ICGA检查可见黄斑区片状弱荧光8只眼。OCT检查,所有患眼黄斑区外丛状层(OPL)、外核层(ONL)可见斑片状强反射,外界膜、椭圆体带部分缺失;横断面OCT检查可见视网膜OPL、ONL间“花瓣样”强反射。行视野检查的18只眼中,中心暗点15只眼。结论COVID-19相关AMN特征性表现为黄斑区斑点状或类圆状灰白色病灶;IR表现为病变区呈片状弱反射;OCT表现为OPL、ONL呈强反射;横断面OCT表现为OPL、ONL间“花瓣样”强反射。
Objective To observe the multimodal imaging features of acute macular neuroretinopathy(AMN)associated with COVID-19.Methods A retrospective case study.A total of 52 eyes of 26 patients of AMN associated with COVID-19 diagnosed in Handan Eye Hospital from December 8 to 20,2022 were included in the study.There were 8 males and 18 females,with the mean age of(33.8±8.1)years.All the patients were bilateral.The time from diagnosis of COVID-19 to the onset of vision loss was 3 to 6 days.All patients underwent the examinations of best corrected visual acuity(BCVA),fundus color photography,infrared fundus photography(IR),fundus autofluorescence(AF),and optical coherence tomography(OCT).Fluorescein fundus angiography(FFA)combined with indoxine green angiography(ICGA)were performed in 12 eyes,and visual field were performed in 18 eyes.Multimodal image features of the affected eye were retrospectively analyzed.Results The BCVA of the affected eye was 0.25 to 1.0.Round or mottled grayish-white lesions in the macular area were seen in all affected eyes.IR examination showed irregular map-like weak reflex in macular region.AF examination showed speckled fluorescence enhancement in lesion related areas in 3 eyes.FFA combined with ICGA showed weak fluorescence in the macular region in 8 eyes.OCT examination showed patchy strong reflection in the outer plexus layer(OPL)and outer nuclear layer(ONL)of macular area in all affected eyes,and partial absence of outer membrane and ellipsoid band.The en-face OCT showed petal-like intense refleciton between OPL and ONL.Eighteen eyes underwent visual field,and 15 eyes had central dark spots.Conclusion The characteristic manifestations of AMN associated with COVID-19 are speckled or round-like grayish-white lesions in the macular area,weak reflexes in IR,enhanced OPL and ONL reflexes in OCT,and petal-like intense refleciton changes between OPL and ONL can be seen in en-face OCT.
作者
张树军
吕爱国
王艳娜
Zhang Shujun;Lyu Aiguo;Wang Yanna(Handan Eye Hospital(The Third Hospital of Handan),Handan 056006,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2023年第3期204-207,共4页
Chinese Journal of Ocular Fundus Diseases
