新型冠状病毒相关视网膜病变多模式影像学特征观察
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南京医科大学眼科医院 江苏 南京 210029

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国家自然科学基金项目(面上项目)编号:82271107


Multimodal imaging features of COVID-19-related retinopathy
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1.Affiliated Eye Hospital of Nanjing Medical University,Nanjing,210029;2.China

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NSFC Grant No. 82271107

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    摘要:

    目的:观察新型冠状病毒相关的视网膜病变并总结其多模式影像学特征。方法:回顾性病例分析。纳入2022年12月~2023年2月新型冠状病毒相关性视网膜病变在南京医科大学眼科医院就诊的患者,共9例16眼。患眼行最佳矫正视力(best corrected visual acuity,BCVA)、眼压检查、眼底照相(fundus photography,FP)、频域光学相干断层扫描 (spectral-domain optical coherence tomography,SD-OCT)、荧光素眼底血管造影 (fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiograph,ICGA)及光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA) 检查。结果:9例16眼中单一影像学改变表现者6例11眼,两种共同存在者3例5眼。其中:①有视网膜血管炎表现者4例7眼。眼底检查可见受累处视网膜静脉血管扩张, FFA 检查可见受累处静脉血管扩张迂曲,晚期荧光着染渗漏明显。当病变累及黄斑区时OCT检查可见外核层不规则片状高反射,椭圆体带反射缺失或不连续,在OCTA的En face图中呈不规则片状低反射区,血流图可见视网膜血流密度降低。②有急性黄斑区神经视网膜病变表现者5例9眼。眼底检查见黄斑中心凹处暗红色病灶;自发荧光呈不规则片状低荧光; ICGA示黄斑区呈不规则片状低荧光并持续至晚期;OCT可见黄斑区中心凹处椭圆体带及RPE层反射欠连续,视网膜外核层呈小片状高反射; En face OCT对应中层视网膜可见病灶区呈不规则絮状高反射区,对应外层视网膜可见椭圆体带缺失处呈不规则斑片状低反射区。③有视神经炎表现者3例5眼。眼底检查可见视盘水肿,境界不清,FFA可见视盘表面毛细血管扩张,晚期呈高荧光渗漏,OCT显示视盘神经纤维层厚度增厚隆起,生理凹陷变浅。结论:新型冠状病毒感染相关的视网膜病变影像学特征具有多样性,多表现为血管炎症、神经组织受累、视神经炎、小血管闭塞等,通过多模式影像学检查可以明确诊断并且观察疾病转归。

    Abstract:

    Objective: To observe the COVID-19-related retinopathy and summarize its multimodal imaging features. Methods: Retrospective analysis. A total of 9 patients with 16 eyes were included. The patients with retinopathy after SARS-CoV-2 infection from December 2022 to February 2023 were included. Best corrected visual acuity (BCVA), intraocular pressure (IOP), and multimodal imaging were conducted on the patients. Results: 6 cases with 11 eyes showed single imaging lesions while 3 cases with 5 eyes showed two lesions that coexist.(1) Retinal vasculitis in 4 cases with 7 eyes. Fundus examination showed retinal vein dilation and frost-like changes at the affected area. FFA examination showed tortuous vascular dilation of the affected vein, with obvious leakage of contrast agent staining in the late phase. When the macular area is involved, OCT examination showed irregular flaky hyperreflection in the outer nuclear layer of the macular area. The reflex of the ellipsoid zone is absent or discontinuous. En face OCT at the corresponding region showed irregular hyporeflection and the corresponding blood flow density reduced. (2) Acute macular neuroretinopathy: 5 cases with 9 eyes. Fundus examination showed irregular dark red lesions in the fovea. The fundus autofluorescence showed irregular flaky hypofluorescence in the affected areas. ICGA showed irregular flaky hypofluorescence in the macular area that lasted until the late stage. OCT showed that the reflex of the ellipsoidal zone and RPE layer in the fovea was not continuous, with the outer nuclear layer showing small flaky hyperreflection. En face OCT showed irregular hyperreflective lesion of the intermediate layer and the irregular patch-like hyporeflective area where the ellipsoidal zone was absent. (3) Optic neuritis 3 case with 5 eyes. Fundus examination showed optic disc edema with unclear borders. FFA showed telangiectasia on the surface of the optic disc and diffuse hyperfluorescence leakage in the late stage. OCT showed thickening of the nerve fiber layer and shallow physiologic cup. Conclusion: The imaging features of retinopathy associated with COVID-19 are diverse, mostly manifested as vascular inflammation, nerve tissue involvement, optic neuritis and microvascular occlusion, etc. The prognosis varies with the degree of disease progression and multimodal imaging can confirm the diagnosis and indicate the disease outcome.

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  • 收稿日期:2023-02-18
  • 最后修改日期:2023-04-26
  • 录用日期:2023-08-29
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