[1]熊淑敏,饶杰,程琪,等.新型冠状病毒感染后急性黄斑神经视网膜病变的多模影像学特征[J].眼科新进展,2023,43(9):712-716.[doi:10.13389/j.cnki.rao.2023.0143]
　XIONG Shumin,RAO Jie,CHENG Qi,et al.Multimodal imaging characteristics of acute macular neuroretinopathy after COVID-19 infection[J].Recent Advances in Ophthalmology,2023,43(9):712-716.[doi:10.13389/j.cnki.rao.2023.0143]
点击复制

新型冠状病毒感染后急性黄斑神经视网膜病变的多模影像学特征/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
43卷
期数:
2023年9期
页码:
712-716
栏目:
应用研究
出版日期:
2023-09-05

文章信息/Info

Title:
Multimodal imaging characteristics of acute macular neuroretinopathy after COVID-19 infection
作者:
熊淑敏; 饶杰; 程琪; 吴晓蓉
330006　江西省南昌市，南昌大学第一附属医院眼科
Author(s):
XIONG Shumin; RAO Jie; CHENG Qi; WU Xiaorong
Department of Ophthalmology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China
关键词:
急性黄斑神经视网膜病变; SD-OCT; 红外成像; En-face结构图; OCTA
Keywords:
acute macular neuroretinopathy;  spectral-domain optical coherence tomography;  infrared imaging;  En-face optical coherence tomography;  optical coherence tomography angiography
分类号:
R774
DOI:
10.13389/j.cnki.rao.2023.0143
文献标志码:
A
摘要:
目的　探讨新型冠状病毒感染后出现的急性黄斑神经视网膜病变（AMN）的多模影像学特征。
方法　回顾性分析南昌大学第一附属医院感染新型冠状病毒后诊断为AMN的患者6例12眼，结合患者病史、临床表现、眼底照相、SD-OCT、OCTA、En-face结构图、眼底自发荧光 （FAF）、红外成像(IR)、荧光素眼底血管造影（FFA）、多焦视网膜电图（mfERG）、视野等检查结果，综合分析AMN的多模影像学特征。
结果　6例患者中女4例，男2例；年龄16~30岁；发病时间3~15 d;2例4眼属于急性期AMN，4例8眼属于进展期AMN。4眼（33.3%）眼底黄斑区可见楔形棕红色病灶；12眼（100.0%）IR可见一个或多个楔形弱反射病灶；SD-OCT示8眼（66.7%）进展期AMN黄斑区视网膜局灶性椭圆体带、嵌合带断裂及缺失，4眼（33.3%）急性期AMN黄斑区视网膜外核层及外丛状层可见高反射病灶；8眼（66.7%）进展期AMN椭圆体带和嵌合带En-face结构图可见片状低反射病灶，4眼（33.3%）急性期AMN深层视网膜En-face结构图可见片状高反射病灶；4眼（33.3%）mfERG示黄斑中心凹一阶反应振幅密度稍降低；6眼（50.0%）视野检查可见一个或多个中心、旁中心暗点。FFA、FAF、OCTA检查均未见明显异常改变。
结论　新型冠状病毒感染后AMN 患者多为青年人，急性发病，眼底改变不明显，多模影像学可实现对AMN的早期诊断。
Abstract:
Objective　To explore the multimodal imaging characteristics of acute macular neuroretinopathy (AMN) after COVID-19 infection.
Methods　Six patients (12 eyes) diagnosed with AMN after COVID-19 infection in the First Affiliated Hospital of Nanchang University were retrospectively analyzed. Based on their medical history, clinical features, and examination results by fundus photography, spectral-domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCTA), En-face optical coherence tomography (OCT), fundus autofluorescence (FAF), infrared imaging (IR), fundus fluorescein angiography (FFA), multifocal electroretinography (mfERG), and perimetry, the multimodal imaging characteristics of AMN were discussed comprehensively.
Results　Four of the six patients were young women and two were young men aged 16 to 30. The disease duration was 3 to 15 days. Four eyes of two patients were in the acute stage and eight eyes of four patients were in the progressive stage. IR showed one or more wedge-shaped brownish-red foci in 4 eyes (33.3%) and wedge-shaped weak reflex foci in 12 eyes (100.0%). SD-OCT results showed that 8 eyes (66.7%) in the progressive stage had the focal ellipsoid zone and broken or missing chimeric zone in the macular region, and 4 eyes (33.3%) in the acute stage had hyperreflective foci in the outer nuclear and plexiform layers of the retina. En-face OCT revealed lamellar hyporeflective foci in the ellipsoid and chimeric zones in the 8 progressive AMN eyes (66.7%) and lamellar hyperreflective foci in the deep retinal layer in the 4 acute AMN eyes (33.3%). mfERG results showed that the amplitude of the first-order response in the macular fovea decreased slightly in 4 eyes (33.3%). Perimetry exhibited one or more central and paracentral dark spots in 6 eyes (50.0%). FFA, FAF and OCTA showed no obvious abnormal changes.
Conclusion　Most of the patients with AMN after COVID-19 infection are young people, with acute onset and no obvious fundus changes. Multimodal imaging can facilitate the early diagnosis of AMN.

参考文献/References:

［1］　BOS P J M,DEUTMAN A F.Acute macular neuroretinopathy［J］.Am J Ophthalmol,1975,80(4):573-584.
［2］　MUNK M R,JAMPOL L M,CUNHA SOUZA E,DE ANDRADE G C,ESMAILI D D,SARRAF D,et al.New associations of classic acute macular neuroretinopathy［J］.Br J Ophthalmol,2016,100(3):389-394.
［3］　LEE D H,LEE S C,KIM M.Acute macular neuroretinopathy associated with systemic lupus erythematosus［J］.Lupus,2016,25(4):431-435.
［4］　PANG C E,NAVAJAS E V,WARNER S J,HEISLER M,SARUNIC M V.Acute macular neuroretinopathy associated with chikungunya fever［J］.Ophthalmic Surg Lasers Imaging Retina,2016,47(6):596-599.
［5］　WALLS A C,PARK Y J,TORTORICI M A,WALL A,MCGUIRE A T,VEESLER D.Structure,function,and antigenicity of the SARS-CoV-2 spike glycoprotein［J］.Cell,2020,181(2):281-292.
［6］　HOFFMANN M,KLEINE-WEBER H,SCHROEDER S,KRGER N,HERRLER T,ERICHSEN S,et al.SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor［J］.Cell,2020,181(2):271-280.
［7］　王莉兰,濮文渊,徐中驰,李杰,周春祥.新型冠状病毒受体ACE2在多种疾病中的作用［J］.中国病理生理杂志,2021,37(1):181-186.
WANG L L,PU W Y,XU Z C,LI J,ZHOU C X.Roles of SARS-CoV-2 receptor ACE2 in various diseases［J］.Chin J Pathophysiol,2021,37(1):181-186.
［8］　ZHOU P,YANG X L,WANG X G,HU B,ZHANG L,ZHANG W,et al.Addendum:a pneumonia outbreak associated with a new coronavirus of probable bat origin［J］.Nature,2020,588(7836) :270-273.
［9］　ZHOU L,XU Z,CASTIGLIONE G M,SOIBERMAN U S,EBERHART C G,DUH E J.ACE2 and TMPRSS2 are expressed on the human ocular surface,suggesting susceptibility to SARS-CoV-2 infection［J］.Ocul Surf,2020,18(4):537-544.
［10］　CHIN M S,HOOPER L C,HOOKS J J,DETRICK B.Identification of α-fodrin as an autoantigen in experimental coronavirus retinopathy (ECOR)［J］.J Neuroimmunol,2014,272(1/2):42-50.
［11］　谢君,姜利斌,王光璐,焦旋,周丹,李倩.急性黄斑区神经视网膜病变一例［J］.中华眼底病杂志,2010,26(6):585-587.
XIE J,JIANG L B,WANG G L,JIAO X,ZHOU D,LI Q.A case of acute macular neuroretinopathy［J］.Chin J Ocul Fundus Dis,2010,26(6):585-587.
［12］　MASCHI C,SCHNEIDER-LISE B,PAOLI V,GASTAUD P.Acute macular neuroretinopathy:contribution of spectral-domain optical coherence tomography and multifocal ERG［J］.Graefes Arch Clin Exp Ophthalmol,2011,249(6):827-831.
［13］　FEIGL B,HAAS A.Optical coherence tomography (OCT) in acute macular neuroretinopathy［J］.Acta Ophthalmol Scand,2000,78(6):714-716.
［14］　AZAR G,WOLFF B,CORNUT P L,SAHEL J A,MAUGET-FASSE M.Spectral domain optical coherence tomography evolutive features in acute macular neuroretinopathy［J］.Eur J Ophthalmol,2012,22(5):850-852.
［15］　SANJARI N,MOEIN H R,SOHEILIAN R,SOHEILIAN M,PEYMAN G A.Enhanced depth imaging OCT and indocyanine green angiography changes in acute macular neuroretinopathy［J］.Ophthalmic Surg Lasers Imaging Retina,2013,44(6 Suppl):S36-S39.
［16］　MENDIS K R,BALARATNASINGAM C,YU P,BARRY C J,MCALLISTER I L,CRINGLE S J,et al.Correlation of histologic and clinical images to determine the diagnostic value of fluorescein angiography for studying retinal capillary detail［J］.Invest Ophthalmol Vis Sci,2010,51(11):5864.
［17］　ROY R,SHAH D,SAURABH K.Multimodal imaging in paracentral acute middle maculopathy［J］.Indian J Ophthalmol,2018,66(8):1186.
［18］　NEMIROFF J,PHASUKKIJWATANA N,SARRAF D.Optical coherence tomography angiography of deep capillary ischemia［J］.Dev Ophthalmol,2016,56:139-145.
［19］　GREWAL D S,POLASCIK B A,KELLY M P,FEKRAT S.Widefield en face optical coherence tomography to quantify the extent of paracentral acute middle maculopathy［J］.Can J Ophthalmol,2017,52(3):e85-e88.
［20］　PECEN P E,SMITH A G,EHLERS J P.Optical coherence tomography angiography of acute macular neuroretinopathy and paracentral acute middle maculopathy［J］.JAMA Ophthalmol,2015,133(12):1478-1480.
［21］　CHU S,NESPER P L,SOETIKNO B T,BAKRI S J,FAWZI A A.Projection-resolved OCT angiography of microvascular changes in paracentral acute middle maculopathy and acute macular neuroretinopathy［J］.Invest Ophthalmol Vis Sci,2018,59(7):2913.
［22］　MATURI R K.Multifocal electroretinographic evaluation of acute macular neuroretinopathy［J］.Arch Ophthalmol,2003,121(7):1068.
［23］　SALOM D,DAZ-LLOPIS M,CERVERA E,GARCA-DELPECH S,HERNNDEZ-GARFELLA M,GARCA-POUS M.Acute macular neuroretinopathy［J］.Arch Soc Esp Oftalmol,2007,82(5):307-309.

相似文献/References:

[1]王怀华,米东明,刘娜,等.COVID-19相关急性黄斑神经视网膜病变的眼底影像学特征[J].眼科新进展,2023,43(7):562.[doi:10.13389/j.cnki.rao.2023.0113]
　WANG Huaihua,MI Dongming,LIU Na,et al.Fundus imaging features of acute macular neuroretinopathy associated with COVID-19 infection[J].Recent Advances in Ophthalmology,2023,43(9):562.[doi:10.13389/j.cnki.rao.2023.0113]

备注/Memo

备注/Memo:
国家自然科学基金地区项目（编号：82160207）； 江西省青年科学基金重点项目（编号： 20202ACBL216008）
更新日期/Last Update: 2023-09-05