专家述评
ENGLISH ABSTRACT
充分认识COVID-19相关眼部损害,努力提高诊疗水平
魏文斌
周楠
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20230103-00004
Fully understand COVID-19 related eye damage to improve the level of diagnosis and treatment
Wei Wenbin
Zhou Nan
Authors Info & Affiliations
Wei Wenbin
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
Zhou Nan
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
·
DOI: 10.3760/cma.j.cn115989-20230103-00004
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摘要

由严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的新型冠状病毒感染(COVID-19)在全球持续大流行,给全球医疗模式带来了深刻影响,更多积累的、新的医学资料提示SARS-CoV-2感染会侵犯患者多个器官,但对其引起的眼部相关病变特征及其危害仍缺乏足够认识。已有的临床资料发现,COVID-19相关眼病主要包括眼表炎性病变和眼后节的视网膜、脉络膜病变,疾病不仅表现为急性炎性反应过程,还可导致视网膜和脉络膜的微血管栓塞性病理过程,给患者,尤其是首诊为眼科的患者视力预后可能带来长期影响,准确诊断COVID-19相关眼病是眼科医生面临的挑战。眼科医生应深入了解SARS-CoV-2感染者眼病相关疾病的发生机制和发展规律,利用目前的眼科多模式影像检查以减少患者相关眼部疾病的漏诊和误诊,及时采取针对性治疗措施,尽可能降低疾病对视功能损害的风险。建议眼科临床工作者开展相关疾病的发病机制研究及多学科临床研究,以降低COVID-19相关眼病患者的致盲率,改善患者的生活质量。

新型冠状病毒感染;严重急性呼吸综合征冠状病毒2型;眼部损害;早期诊断
ABSTRACT

The continuous pandemic coronavirus disease 2019 (COVID-19) in the world has had a profound impact on the global medical model.More accumulated new medical data suggest that severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection will invade multiple organs of patients, but there is still a lack of sufficient understanding of the characteristics of ocular related lesions and their prognosis.The existing clinical data found that COVID-19-related ocular diseases mainly include ocular surface inflammatory lesions and retinopathy and choroidopathy in the posterior segment.The disease is not only an acute inflammatory reaction process, but also can lead to the pathological process of microvascular thrombosis in the retina and choroid, which may have a long-term impact on the visual prognosis of patients, especially those who were initially diagnosed as ophthalmic manifestations.Accurate diagnosis of COVID-19-related ocular diseases is a challenge for ophthalmologists.Ophthalmologists should have a deep understanding of the pathogenesis and development of SARS CoV-2 infected eyes, make use of the current multimodal ophthalmic imaging examination to reduce misdiagnosis and take timely targeted treatment measures to minimize the risk of disease damage to visual function.We suggest that clinical ophthalmologists pay attention to carry out the pathogenesis research of related diseases and multidisciplinary clinical research to reduce the blindness rate of patients with SARS CoV-2 infection and improve patients' quality of life.

COVID-19;SARS-CoV-2;Ocular damage;Early diagnosis
Wei Wenbin, Email: mocdef.3ab61rtnibnewiew
引用本文

魏文斌,周楠. 充分认识COVID-19相关眼部损害,努力提高诊疗水平[J]. 中华实验眼科杂志,2023,41(02):104-109.

DOI:10.3760/cma.j.cn115989-20230103-00004

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2019年12月以来,由严重急性呼吸综合征冠状病毒2型(severe acute respiratory syndrome coronavirus-2,SARS-CoV-2)引起的新型冠状病毒感染(coronavirus disease 2019,COVID-19)在全球范围内引起广泛传播,世界卫生组织于2020年3月宣布COVID-19大流行 [ 1 ]。COVID-19可表现为轻微的全身症状、肺部病变、败血症等,重者可导致急性呼吸窘迫综合征 [ 2 ],进而危及患者生命。既往对COVID-19的诊断和治疗主要聚焦于患者的全身症状,然而,越来越多的临床资料表明,SARS-CoV-2感染会影响眼部多个组织,进而引起不同类型及不同程度的眼部病变。随着病毒的不断变异、患病率的不断攀升,感染后有视力受损主诉的患者也愈发增多。眼球是直接暴露于外界的感觉器官且具有透明的屈光系统,眼球组织解剖结构的特性既决定了眼球容易遭受微生物直接侵袭而发病的特点,同时也提供了可在直视下对眼底血管、神经和其他组织进行直接检查的条件,因此对系统性相关眼病进行研究,不仅有助于眼病的及时治疗,也有助于系统性疾病发病机制的研究,并为病程监测和预后判断提供参考依据。近年来眼科无创影像学检查设备不断更新和进步,如采用光相干断层扫描(optical coherence tomography,OCT)及光相干断层扫描血管成像(optical coherence tomography angiography,OCTA)技术可对视网膜和脉络膜组织、血管达到活体组织学显像的程度,为充分认识COVID-19相关眼病特征、选择规范化诊疗方法提供了可能,但部分COVID-19相关眼部病变仍然是隐匿的。眼科医师应充分了解COVID-19相关眼病的发生机制和相关症状,警惕COVID-19相关眼病。
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备注信息
A
魏文斌,Email: mocdef.3ab61rtnibnewiew
B
所有作者均声明不存在利益冲突
C
国家自然科学基金项目 (82220108017、82141128)
首都卫生发展科研专项项目 (2020-1-2052)
北京市科委科技计划项目 (Z201100005520045、Z181100001818003)
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