Acute Macular Neuroretinopathy Associated with COVID-19 Pandemic: A Real-world Observation Study

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology Pub Date : 2024-09-01 DOI:10.1016/j.apjo.2024.100103

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Abstract

Purpose

To evaluate the clinical and retinal imaging features of Chinese patients with acute macular neuroretinopathy (AMN) associated with COVID-19.

Design

A prospective observational study.

Methods

Retinal imaging, including color fundus photography, near-infrared imaging (NIR), swept-source optical coherence tomography (SS-OCT), optical coherence tomography angiography (OCTA), and Humphrey perimetry, were conducted for each case.

Results

All cases were included within the first three months following the pandemic outbreak. A total of 12 male patients (36.36 %) and 21 female patients (63.64 %) were prospectively recruited, and 29 cases (87.88 %) were bilaterally affected. The median interval between the onset of fever and the appearance of ocular symptoms was two days (range, 0.5–5.0 days). Apart from the outer retinal changes typical of AMN, changes in the inner retinal layers were observed, including intraretinal hemorrhage (8.06 %), cotton wool spots (9.68 %), and paracentral acute middle maculopathy (PAMM) (8.06 %). Smaller retinal inner nuclear layer hyperreflective speckles (RIHS) (41.94 %) were identified as a distinguishing feature from typical PAMM. Voids of vessel signals were found in the superficial (11.54 %), intermediate (82.69 %), and deep capillary plexus (98.08 %), and in the choriocapillaris (19.23 %) on OCTA. Humphrey perimetry illustrated central, paracentral, and peripheral scotomas. The occult lesions associated with AMN, PAMM, and some of the RIHS illustrated by OCT were visualized topographically and further confirmed by OCTA as perfusion defects.

Conclusion

An increase in AMN cases correlated with the SARS-CoV-2 outbreak. Additional features, including widespread inner retinal perfusion deficits, were observed and may serve as potential biomarkers for systemic microcirculation dysregulation in COVID-19.

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与 COVID-19 大流行相关的急性黄斑神经视网膜病变：真实世界观察研究

目的：评估与COVID-19相关的中国急性黄斑神经视网膜病变（AMN）患者的临床和视网膜成像特征：前瞻性观察研究：方法：对每个病例进行视网膜成像，包括彩色眼底照相、近红外成像（NIR）、扫源光学相干断层扫描（SS-OCT）、光学相干断层血管成像（OCTA）和汉弗莱视网膜测量：结果：所有病例都是在大流行爆发后的头三个月内发现的。前瞻性招募了 12 名男性患者（36.36%）和 21 名女性患者（63.64%），29 例患者（87.88%）为双侧受累。从发烧到出现眼部症状的中位间隔为两天（0.5-5.0 天不等）。除了AMN典型的视网膜外层变化外，还观察到视网膜内层的变化，包括视网膜内出血（8.06%）、棉絮斑（9.68%）和旁中心急性中间黄斑病变（PAMM）（8.06%）。较小的视网膜核内层高反射斑点（RIHS）（41.94%）被确定为区别于典型 PAMM 的特征。在 OCTA 上，表层（11.54%）、中间层（82.69%）和深层毛细血管丛（98.08%）以及绒毛膜（19.23%）都发现了血管信号空洞。汉弗莱视网膜测图显示了中心、旁中心和周边视网膜灶。OCT显示的与AMN、PAMM和部分RIHS相关的隐匿性病变可通过地形图观察到，并通过OCTA进一步证实为灌注缺损：结论：AMN病例的增加与SARS-CoV-2爆发有关。结论：AMN病例的增加与SARS-CoV-2疫情有关，同时还观察到其他特征，包括广泛的视网膜内部灌注缺陷，这些特征可能成为COVID-19中全身微循环失调的潜在生物标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asia-Pacific Journal of Ophthalmology OPHTHALMOLOGY-

CiteScore

8.10

自引率

18.20%

发文量

197

审稿时长

6 weeks

期刊介绍： The Asia-Pacific Journal of Ophthalmology, a bimonthly, peer-reviewed online scientific publication, is an official publication of the Asia-Pacific Academy of Ophthalmology (APAO), a supranational organization which is committed to research, training, learning, publication and knowledge and skill transfers in ophthalmology and visual sciences. The Asia-Pacific Journal of Ophthalmology welcomes review articles on currently hot topics, original, previously unpublished manuscripts describing clinical investigations, clinical observations and clinically relevant laboratory investigations, as well as .perspectives containing personal viewpoints on topics with broad interests. Editorials are published by invitation only. Case reports are generally not considered. The Asia-Pacific Journal of Ophthalmology covers 16 subspecialties and is freely circulated among individual members of the APAO’s member societies, which amounts to a potential readership of over 50,000.