Midena Edoardo, Cosmo Eleonora, Cattelan Anna Maria, Briani Chiara, Leoni Davide, Capizzi Alfio, Tabacchi Vanessa, Parrozzani Raffaele, Midena Giulia, Frizziero Luisa
Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy.
IRCCS-Fondazione Bietti, 00198 Rome, Italy.
J Pers Med. 2022 Apr 1;12(4):563. doi: 10.3390/jpm12040563.
A large spectrum of neurological manifestations has been associated with coronavirus disease 2019 (COVID-19), and recently, the involvement of small fibers has been suggested. This study aims to investigate the involvement of small peripheral nervous fibers in recovered COVID-19 patients using in-vivo corneal confocal microscopy (CCM). Patients recovered from COVID-19 and a control group of healthy subjects underwent in-vivo CCM. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal nerve fiber total branch density (CTBD), corneal nerve fiber area (CNFA), corneal nerve fiber width (CNFW), fiber tortuosity (FT), number of beadings (NBe), and dendritic cells (DC) density were quantified. We enrolled 302 eyes of 151 patients. CNBD and FT were significantly higher (p = 0.0131, p < 0.0001), whereas CNFW and NBe were significantly lower (p = 0.0056, p = 0.0045) in the COVID-19 group compared to controls. Only CNBD and FT resulted significantly correlated to antiviral drugs (increased) and corticosteroids (decreased). No significant relationship with disease severity parameters was found. COVID-19 may induce peripheral neuropathy in small fibers even months after recovery, regardless of systemic conditions and therapy, and CCM may be a useful tool to identify and monitor these morphological changes.
多种神经系统表现与2019冠状病毒病（COVID-19）相关，最近，有人提出小纤维也受到累及。本研究旨在使用活体角膜共焦显微镜（CCM）调查康复的COVID-19患者中小的外周神经纤维的累及情况。从COVID-19中康复的患者和一组健康对照受试者接受了活体CCM检查。对角膜神经纤维密度（CNFD）、角膜神经分支密度（CNBD）、角膜神经纤维长度（CNFL）、角膜神经纤维总分支密度（CTBD）、角膜神经纤维面积（CNFA）、角膜神经纤维宽度（CNFW）、纤维迂曲度（FT）、串珠数量（NBe）和树突状细胞（DC）密度进行了量化。我们纳入了151例患者的302只眼。与对照组相比，COVID-19组的CNBD和FT显著更高（p = 0.0131，p < 0.0001），而CNFW和NBe显著更低（p = 0.0056, p = 0.0045）。只有CNBD和FT与抗病毒药物（增加）和皮质类固醇（减少）显著相关。未发现与疾病严重程度参数有显著关系。COVID-19即使在康复数月后也可能诱发小纤维外周神经病变，无论全身状况和治疗如何，并且CCM可能是识别和监测这些形态学变化的有用工具。
