[Multimodal imaging features of acute macular retinopathy in patients with COVID-19].

Objective: To investigate the multimodal imaging characteristics of acute macular retinopathy (AMR) and/or parafoveal acute middle maculopathy (PAMM) in patients with coronavirus disease 2019 (COVID-19). Methods: It was a cross-sectional study. Eight patients (15 eyes) diagnosed with AMN and/or PAMM, who presented for their initial visit at Kaifeng Eye Hospital between December 17 and December 31, 2022 and were also confirmed positive for COVID-19, were enrolled as the observation group. The patients were classified into four types based on swept-source optical coherence tomography (SS-OCT) findings. Fifteen healthy volunteers (15 eyes) without ocular or systemic diseases were recruited as the healthy control group, and one eye was randomly selected for analysis. All participants underwent detailed ophthalmic examinations, including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, fundus photography (FP), intraocular pressure measurement, fundus infrared imaging, OCT and OCT angiography (OCTA). The foveal avascular zone (FAZ) area of the macular center was measured. General information and multimodal imaging findings were collected and analyzed. The superficial capillary plexus vessel density (SCP-VD) and deep capillary plexus vessel density (DCP-VD) were measured in circular areas with diameters of 1.0 mm, >1.0 mm and ≤3.0 mm, and>3.0 mm and ≤6.0 mm centered on the foveal center, recorded as SCP-VD1.0, 3.0, 6.0 and DCP-VD1.0, 3.0, 6.0. Statistical analyses were performed using t-tests, Mann-Whitney U tests, and chi-square tests. Results: The observation group consisted of 6 males (11 eyes) and 2 females (4 eyes) with a mean age of (26.87±11.56) years. The healthy control group included 11 males (11 eyes) and 4 females (4 eyes) with a mean age of (28.75±12.30) years. There were no statistically significant differences in age and gender distribution between the two groups (all P>0.05). All patients in the observation group experienced high fever (≥39.0 ℃) and developed ocular symptoms during the febrile period or within 24 hours after fever resolution. Among all patients, there were 5 cases (7 eyes) of Type Ⅰ, 1 case (1 eye) of Type Ⅱ, 3 cases (4 eyes) of Type Ⅲ, and 2 cases (3 eyes) of Type Ⅳ. In Type Ⅲ and Ⅳ, 3 cases (4 eyes) exhibited weakly reflective cystic spaces in the outer plexiform or outer nuclear layers, and fundus photography revealed multiple gray or reddish-brown lesions in the macular region. One case (1 eye) showed retinal superficial hemorrhage. Cotton wool spots were observed in 2 cases (4 eyes). Fundus infrared imaging showed that Type Ⅰ manifested as weak reflectivity lesions in the parafoveal central zone, with the tip pointing towards the fovea. Type Ⅱ showed no apparent abnormalities in the macular region, while Type Ⅲ and Ⅳ displayed map-like weak reflective lesions spanning the foveal center. OCTA findings demonstrated that SCP-VD1.0 in the observation group was 6.93% (4.77%, 6.93%), significantly lower than the healthy control group's 10.66% (8.05%, 10.55%) (U=174.00, P=0.016). SCP-VD3.0 in the observation group was 37.14% (32.15%, 43.48%), also lower than the healthy control group's 43.06% (38.95%, 46.55%) (U=174.00, P=0.016). DCP-VD3.0 in the observation group was 48.20% (46.11%, 50.33%), lower than the healthy control group's 51.10% (50.04%, 53.02%) (U=188.00, P=0.009). DCP-VD6.0 in the observation group was 49.27% (47.26%, 51.67%), lower than the healthy control group's 52.43% (50.07%, 53.82%) (U=70.00, P=0.004). There were no significant differences in SCP-VD6.0 and DCP-VD1.0 between the two groups (both P>0.05). Conclusions: Acute macular retinopathy in patients with COVID-19 can involve all retinal layers and present as segmental hyper-reflectivity on SS-OCT. Fundus infrared imaging reveals weak reflectivity in the affected area, fundus photography shows multiple gray or reddish-brown lesions in the macular region, and OCTA demonstrates a decrease in SCP-VD and DCP-VD.目的： 探讨新型冠状病毒感染患者急性黄斑视网膜病变的多模态影像学特征。 方法： 横断面研究。收集2022年12月17至31日于开封市眼病医院初次诊断为急性黄斑神经视网膜病变（AMN）和（或）旁中心急性黄斑中层视网膜病变（PAMM），且就诊前新型冠状病毒核酸检测或抗原检测阳性的患者8例（15只眼），作为观察组，并根据SS-OCT表现将患者分为4型。招募无眼科和（或）全身疾病的15名（15只眼）健康志愿者为健康对照组，以抽签方式随机选取1只眼为受试眼。所有受试者均行详细眼科检查，包括最佳矫正视力（BCVA）检查、裂隙灯显微镜检查、眼底激光照相（FLP）、眼压检查、眼底红外成像、相干光层析成像术（OCT）和相干光层析血管成像术（OCTA）检查，测量受试眼黄斑中心凹无血管区（FAZ）面积。收集并分析受试者的一般资料和多模态影像检查结果。测量以黄斑中心凹为中心，直径1.0 mm、>1.0 mm且≤3.0mm、>3.0 mm且≤6.0 mm环形区域的视网膜浅层毛细血管丛血管密度（SCP-VD）和层毛细血管丛血管密度（DCP-VD），分别记录为SCP-VD1.0、3.0、6.0和DCP-VD1.0、3.0、6.0。采用t检验、Mann-Whitney U检验和χ2检验进行统计学分析。 结果： 观察组男性6例（11只眼），女性2例（4只眼）；年龄为（26.87±11.56）岁。健康对照组男性11例（11只眼），女性4例（4只眼）；年龄为（28.75±12.30）岁。两组年龄与性别构成差异均无统计学意义（均P>0.05）。观察组患者均出现体温≥39.0 ℃的高热，且在发热期间或退烧后24 h内出现眼部症状。所有患者中，Ⅰ型5例（7只眼），Ⅱ型1例（1只眼），Ⅲ型3例（4只眼），Ⅳ型2例（3只眼）。Ⅲ、Ⅳ型中3例（4只眼）出现外丛状层或外核层弱反射囊腔，FLP检查发现黄斑区可见多个灰色或红褐色病灶。1例（1只眼）可见视网膜浅层出血。2例（4只眼）眼底可见棉绒斑。眼底红外光检查显示，Ⅰ型表现为黄斑旁中心区弱反射病变，尖端指向中心凹，Ⅱ型黄斑区未见明显异常，Ⅲ、Ⅳ型表现为跨越黄斑中心凹的地图状弱反射病变。OCTA检查结果显示，观察组SCP-VD1.0为6.93%（4.77%，6.93%），低于健康对照组的10.66%（8.05%，10.55%），差异有统计学意义（U=174.00，P=0.016）；观察组SCP-VD3.0为37.14%（32.15%，43.48%），低于健康对照组的43.06%（38.95%，46.55%），差异有统计学意义（U=174.00，P=0.016）；观察组DCP-VD3.0为48.20%（46.11%，50.33%），低于健康对照组的51.10%（50.04%，53.02%），差异有统计学意义（U=188.00，P=0.009）；观察组DCP-VD6.0为49.27%（47.26%，51.67%），低于健康对照组的52.43%（50.07%，53.82%），差异有统计学意义（U=70.00，P=0.004）。两组间SCP-VD6.0和DCP-VD1.0比较，差异无统计学意义（均P>0.05）。 结论： 新型冠状病毒感染患者的急性黄斑视网膜病变可累及视网膜全层，SS-OCT表现为病变区域节段性强反射，眼底红外光表现为病变区域弱反射，FLP表现为黄斑区多个灰色或红褐色病灶，OCTA表现为SCP-VD和DCP-VD下降。.