COVID-19 相关视网膜微血管病变——现有证据的综述。
COVID-19-Related Retinal Micro-vasculopathy - A Review of Current Evidence.
机构信息
From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore (K.Y.C.T, C.M.G.C); Duke-NUS Medical School, National University of Singapore, Singapore (K.Y.C.T, C.M.G.C); Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia (K.Y.C.T, A.I).
Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia (K.Y.C.T, A.I); Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy (A.I, G.S).
出版信息
Am J Ophthalmol. 2022 Mar;235:98-110. doi: 10.1016/j.ajo.2021.09.019. Epub 2021 Sep 26.
PURPOSE
To evaluate the occurrence of retinal microvasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who developed coronavirus disease (COVID-19).
DESIGN
Systematic review and meta-analysis.
METHODS
The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analyzed in RevMan Web versions 3.3. Quality of evidence was assessed using the National Institute of Health quality assessment tool for a case-control study.
RESULTS
Thirty-one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case-control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal microvasculopathy in subjects with COVID-19 compared to controls (odds ratio [95% confidence interval], 8.86 [2.54-27.53], P < .01). Optical coherence tomography angiography (OCTA) revealed reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls.
CONCLUSIONS
The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might have occurred antecedent to clinically visible changes and could be detected earlier by OCTA. These findings are significant, due to the large numbers with COVID-19, and need to be recognized by ophthalmologists as a potential long-term sequalae of the disease.
目的
评估严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染并发生冠状病毒病（COVID-19）的患者中视网膜微血管病变的发生情况。
设计
系统评价和荟萃分析。
方法
全面检索 Pubmed 和 Embase 数据库，以确定报告 COVID-19 眼中视网膜血管变化的研究。两名独立的审查员选择论文并提取数据进行分析。提取并在 RevMan Web 版本 3.3 中分析感兴趣的数据。使用国家卫生研究院病例对照研究质量评估工具评估证据质量。
结果
纳入了 31 项研究，共报告了 1373 例受试者（972 例 COVID-19 和 401 例对照）。仅纳入了病例对照研究进行汇总分析。与对照组相比，COVID-19 患者发生视网膜微血管病变的可能性显著更高（比值比[95%置信区间]，8.86[2.54-27.53]，P<.01）。与对照组相比，COVID-19 患者的光学相干断层扫描血管造影（OCTA）显示血管密度降低和中心凹无血管区扩大。
结论
结果表明，COVID-19 相关的视网膜微血管病变是 COVID-19 的一种重要眼部表现，可能预示着未来的视网膜并发症。这些微血管损伤可能先于临床可见的变化发生，并可通过 OCTA 更早地检测到。这些发现意义重大，因为 COVID-19 患者数量众多，眼科医生需要认识到这可能是该疾病的一种潜在长期后遗症。
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