COVID-19 的眼部表现。

IF 18.6 1区 医学 Q1 OPHTHALMOLOGY Progress in Retinal and Eye Research Pub Date : 2024-06-24 DOI:10.1016/j.preteyeres.2024.101285
Hannah W. Ng , Daniel A.R. Scott , Helen V. Danesh-Meyer , Justine R. Smith , Charles NJ. McGhee , Rachael L. Niederer
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引用次数: 0

摘要

关于 COVID-19 如何与不同严重程度和持续时间的眼部疾病相关的知识越来越多。本文讨论了与 COVID-19 相关的眼部表现的文献,包括对现有证据的评估、建议的作用机制、相关合并症和风险因素、从初次感染到诊断的时间以及临床警示。目前的文献主要包括病例报告和系列病例,不可避免地缺乏对照组和支持因果关系的证据。不过,这些早期数据促使人们开始进行更大规模的人群研究和实验室研究。随着新数据的出现,将有可能更好地评估 COVID-19 对眼睛的真正影响。尽管世界卫生组织(WHO)已于 2023 年 5 月正式宣布 COVID-19 大流行不再是 "全球卫生紧急事件",但病例数仍在继续上升。据预测,不同变种的再感染将导致疾病的累积负担不断增加,特别是随着更多的慢性、多器官后遗症变得明显,并可能对眼部产生重大影响。据推测,COVID-19 的眼部表现主要有三种机制:首先,与炎症性眼病有关的初始感染导致免疫反应失调;其次,COVID-19 患者更倾向于处于高凝状态,导致血栓形成前兆;第三,需要住院治疗的严重 COVID-19 患者因使用皮质类固醇或糖尿病等合并症而导致免疫抑制,继发感染(包括眼内炎和鼻眶粘液瘤病)的风险增加。因此,已报告的与 COVID-19 相关的眼科疾病包括结膜炎、巩膜炎、葡萄膜炎、内源性眼内炎、角膜移植排斥反应、视网膜动静脉闭塞、非动脉缺血性视神经病变、青光眼、神经系统和眼眶后遗症等一系列疾病。鉴于 COVID-19 的传染性,有必要考虑远程医疗会诊,了解感染期间或感染后可能出现的一系列眼部疾病对于确保对患者进行适当分流、及时进行现场眼部检查以治疗可能危及视力和生命的疾病至关重要。
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Ocular manifestations of COVID-19

There is an increasing body of knowledge regarding how COVID-19 may be associated with ocular disease of varying severity and duration. This article discusses the literature on the ocular manifestations associated with COVID-19, including appraisal of the current evidence, suggested mechanisms of action, associated comorbidities and risk factors, timing from initial infection to diagnosis and clinical red flags. The current literature primarily comprises case reports and case series which inevitably lack control groups and evidence to support causality. However, these early data have prompted the development of larger population-based and laboratory studies that are emerging. As new data become available, a better appraisal of the true effects of COVID-19 on the eye will be possible.

While the COVID-19 pandemic was officially declared no longer a “global health emergency” by the World Health Organization (WHO) in May 2023, case numbers continue to rise. Reinfection with different variants is predicted to lead to a growing cumulative burden of disease, particularly as more chronic, multi-organ sequelae become apparent with potentially significant ocular implications.

COVID-19 ocular manifestations are postulated to be due to three main mechanisms: firstly, there is a dysregulated immune response to the initial infection linked to inflammatory eye disease; secondly, patients with COVID-19 have a greater tendency towards a hypercoagulable state, leading to prothrombotic events; thirdly, patients with severe COVID-19 requiring hospitalisation and are immunosuppressed due to administered corticosteroids or comorbidities such as diabetes mellitus are at an increased risk of secondary infections, including endophthalmitis and rhino-orbital-mucormycosis. Reported ophthalmic associations with COVID-19, therefore, include a range of conditions such as conjunctivitis, scleritis, uveitis, endogenous endophthalmitis, corneal graft rejection, retinal artery and vein occlusion, non-arteritic ischaemic optic neuropathy, glaucoma, neurological and orbital sequelae.

With the need to consider telemedicine consultation in view of COVID-19's infectivity, understanding the range of ocular conditions that may present during or following infection is essential to ensure patients are appropriately triaged, with prompt in-person ocular examination for management of potentially sight-threatening and life-threatening diseases.

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来源期刊
CiteScore
34.10
自引率
5.10%
发文量
78
期刊介绍: Progress in Retinal and Eye Research is a Reviews-only journal. By invitation, leading experts write on basic and clinical aspects of the eye in a style appealing to molecular biologists, neuroscientists and physiologists, as well as to vision researchers and ophthalmologists. The journal covers all aspects of eye research, including topics pertaining to the retina and pigment epithelial layer, cornea, tears, lacrimal glands, aqueous humour, iris, ciliary body, trabeculum, lens, vitreous humour and diseases such as dry-eye, inflammation, keratoconus, corneal dystrophy, glaucoma and cataract.
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