Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.
Department of Neurology, Alfred Health, 55 Commercial Road, Melbourne, 3004, Australia.
Clin Exp Ophthalmol. 2023 May-Jun;51(4):370-379. doi: 10.1111/ceo.14221. Epub 2023 Mar 22.
COVID-19 has had a significant impact on the global population and has produced compelling evidence of non-pulmonary organ dysfunction, including the nervous system. It is vital that specialists in ophthalmology and neurology are informed of the potential complications of COVID-19 and gain a deeper understanding of how COVID-19 can cause diseases of the nervous system. In this review we detail four possible mechanisms by which COVID-19 infection may result in neurological or neuro-ophthalmological complications: (1) Toxic and metabolic effects of severe pulmonary COVID-19 disease on the neural axis including hypoxia and the systemic hyper-inflammatory state, (2) endothelial dysfunction, (3) dysimmune responses directed again the neuroaxis, and (4) direct neuro-invasion and injury by the virus itself. We explore the pathological evidence for each of these and how they may link to neuro-ophthalmological disorders. Finally, we explore the evidence for long-term neurological and neuro-ophthalmological complications of COVID-19, with a focus on neurodegeneration.
新型冠状病毒肺炎（COVID-19）对全球人口造成了重大影响，并提供了令人信服的非肺部器官功能障碍的证据，包括神经系统。眼科和神经科专家必须了解 COVID-19 的潜在并发症，并深入了解 COVID-19 如何导致神经系统疾病。在这篇综述中，我们详细介绍了 COVID-19 感染可能导致神经或神经眼科并发症的四种可能机制：（1）严重肺部 COVID-19 疾病对包括缺氧和全身炎症状态在内的神经轴的毒性和代谢作用，（2）内皮功能障碍，（3）针对神经轴的自身免疫反应，以及（4）病毒本身的直接神经入侵和损伤。我们探讨了这些机制中的每一种的病理证据，以及它们如何与神经眼科疾病相关联。最后，我们探讨了 COVID-19 的长期神经和神经眼科并发症的证据，重点是神经退行性变。
