PCR POZİTİF VE NEGATİF COVID-19 HASTALARINDA OPTİK KOHERENS TOMOGRAFİSİ İLE OPTİK SİNİR VE RETINAL KATMAN ÖLÇÜMLERİ

Yıl 2022, Cilt: 12 Sayı: 4, 495 - 499, 31.07.2022

Nihat Aydın Mustafa Çapraz

https://doi.org/10.16899/jcm.1081927

Cited By: 1

Öz

Giriş ve Amaç
Covid-19 sadece akciğerleri değil tüm doku ve organ sistemlerini hedef almaktadır. Kapsamlı mikrovasküler beslenmeye sahip optik sinir ve retina viral tutuluma yatkındır. Optik koherens tomografi, hem optik sinir hem de retina yapısı hakkında detaylı bilgi veren bir teknolojidir. Çalışma, Covid-19 enfeksiyonu olan PCR pozitif ve negatif hastaların optik sinir ve retina yapısındaki olası değişiklikleri araştırmak amacıyla gerçekleştirilmiştir.
Metod
Çalışmaya farklı yaş ve farklı başvuru şikayetlerine sahip PCR pozitif 30 Covid-19 hastası dahil edildi. Benzer yaş ve cinsiyet grubundaki yirmi beş PCR negatif Covid-19 hastası karşılaştırma yapabilmek adına ikincil bir grup olarak tanımlandı. Tüm hastalara yarık lamba biyomikroskopisi, fundoskopi ve OCT dahil oftalmolojik muayene yapıldı. Bu muayeneler, zorunlu izolasyona tam uyum için Covid-19 tanısından dört hafta sonra yapıldı. Ayrıca RNFL, retina kalınlığı ve retina hacmi ölçümleri yapıldı.
Sonuç
RNFL ölçümlerinde her iki göz için karşılaştırmalı analiz yapıldığında PCR pozitif Covid-19 hastaları ile PCR negatif grup arasında herhangi bir parametrede istatistiksel anlamlılık gözlenmedi. Retina kalınlığı ölçümlerinde sol göz santral retina kalınlığı açısından PCR pozitif ve negatif gruplar arasında anlamlı fark vardı (p=0.047). Bununla birlikte, retina hacim ölçümlerinde istatistiksel bir fark yoktu.
Tartışma
Optik koherens tomografi ile retina görüntüleme, COVID-19 sırasında subklinik veya aşikar retina patolojilerinin tespit edilebildiği, invazif olmayan, tekrarlanabilir ve hızlı bir tekniktir. Bu nedenle COVID-19 hastalarının yönetimi, özellikle baş ağrısı ve oküler ağrısı olan hastalarda yakın takip ile retina değerlendirmesini içermelidir.

Anahtar Kelimeler

OCT, RNFL, Covid-19, Optik Sinir

OPTIC NERVE AND RETINAL LAYER MEASUREMENTS WITH OPTICAL COHERENCE TOMOGRAPHY IN PCR POSITIVE AND NEGATIVE COVID-19 PATIENTS

Öz

Objective and Aim
Covid-19 targets all tissue and organ systems, not just the lungs. The optic nerve and retina with extensive microvascular nutrition are prone to viral involvement. Optical coherence tomography is a technology that provides detailed information about both optic nerve and retinal structure. The study was carried out to investigate possible changes in the optic nerve and retinal structure of patients with Covid-19 infection, dividing PCR positivity or negativity.
Methods
Thirty PCR positive Covid-19 patients with different ages and varying admission complaints were included in the study. Twenty-five Covid-19 patients who were PCR negative with similar age and gender were selected as a secondary group for comparison. All patients underwent ophthalmologic examination, including slit-lamp biomicroscopy, funduscopy, and OCT. These examinations were performed four weeks after the diagnosis of Covid-19 for full compliance with the mandatory isolation. In addition, RNFL, retinal thickness, and retinal volume measurements were performed.
Results
No statistical significance was observed in any parameter between the PCR positive or negative patients when the comparative analysis for both eyes in RFNL measurements. There was a significant difference in retinal thickness measurements between the PCR positive and negative groups regarding left eye central retinal thickness (p=0.047). However, there was no statistical difference in retinal volume measurements.
Conclusion
Retinal imaging with optical coherence tomography is a non-invasive, reproducible, and rapid technique in which subclinical or overt retinal pathologies can be detected during COVID-19. Therefore, management of COVID-19 patients should include retinal assessment with close follow-up, especially in patients with headaches and optic pain.

Anahtar Kelimeler

OCT, RNFL, Covid-19, Optic Nerve

Kaynakça

• Referans1. Hoffmann, M.; Kleine-Weber, H.; Schroeder, S.; Krüger, N.; Herrler, T.; Erichsen, S.; Schiergens, T.S.; Herrler, G.; Wu, N.H.; Nitsche, A.; et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020, 181, 271–280.
• Referans2. Güemes-Villahoz N, Burgos-Blasco B, García-Feijoó J, et al. Conjunctivitis in COVID-19 patients: frequency and clinical presentation. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2501–2507.
• Referans3. Seah I and Agrawal R. Can the coronavirus disease 2019 (COVID-19) affect the eyes? A review of coronaviruses and optic implications in humans and animals. Ocul Immunol Inflamm 2020; 28(3): 391–395.
• Referans4. Verma, A.; Shan, Z.; Lei, B.; Yuan, L.; Liu, X.; Nakagawa, T.; Grant, M.B.; Lewin, A.S.; Hauswirth, W.W.; Raizada, M.K.; et al. ACE2 and Ang-(1-7) confer protection against the development of diabetic retinopathy. Mol. Ther. 2012, 20, 28–36.
• Referans5. Amesty, M.A.; Alió del Barrio, J.L.; Alió, J.L. COVID-19 Disease and Ophthalmology: An Update. Ophthalmol. Ther. 2020, 9, 1–12.
• Referans6. Burgos-Blasco B, Guemes-Villahoz N, Donate-Lopez J, et al. Optic nerve analysis in COVID-19 patients. J Med Virol. 2021; 93(1): 190–191.
• Referans7. Medeiros FA, Zangwill LM, Bowd C, et al. Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography. Am J Ophthalmol 2005; 139(1): 44–55.
• Referans8. Lamirel C, Newman NJ and Biousse V. Optical coherence tomography (OCT) in optic neuritis and multiple sclerosis. Rev Neurol (Paris) 2010; 166(12): 978–986.
• Referans9. Hee MRIzatt JASwanson EA et al. Optical coherence tomography of the human retina. Arch Ophthalmol. 1995;113325- 332.
• Referans10. Schuman JSHee MRPuliafito CA et al. Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol. 1995;113586- 596.
• Referans11. Baumann MGentile RCLiebmann JMRitch R Reproducibility of retinal thickness measurements in normal eyes using optical coherence tomography. Ophthalmic Surg Lasers. 1998;29280- 285.
• Referans12. Marinho PM, Amarcos AA, Romano AC, Nascimento H, Belfort Jr R (2020) Retinal findings in patients with COVID-19. Lancet 395(10237):1610-16.
• Referans13. Vasvas DG, Sarraf D, Sadda SR, Eliott D, Ehlers JP, Waheed NK, et al. (2020) Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent Lancet publication. Eye (London) 9:1-2.
• Referans14. Pereira LA, Soares LCM, Nascimento PA, Cirillo LRN, Sakuma HT, Veiga GLD, et al. (2020) Retinal findings in hospitalized patients with severe COVID-19. Br. J Ophthalmol Doi: 10.1136/bjophthalmol-2020-317576.
• Referans15. Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, et al (2020) COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med https://doi.org/10.1111/joim.13156.
• Referans16. Invernizzi A, Torre A, Parrulli S, Zicarelli F, Schiuma M, Colombo V et al. (2020) Retinal findings in patients with COVID-19: Results from the SERPICO-19 study. E Clinical Medicine 27:100550. doi: 10.1016/j.eclinm.2020.100550. Epub 2020 Sep 20. PMID: 32984785; PMCID: PMC7502280.
• Referans17. Zapata MA, Banderas Garcia S, Sanchez-Moltalva A, Falco A, Otero-Romero S, Arcos G et al. (2020) Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity. Br J Ophthalmol bjophthalmol-2020-317953. doi:10.1136/bjophthalmol-2020-317953.
• Referans18. Dag Seker E, Erbahceci Timur IE. COVID-19: more than a respiratory virus, an optical coherence tomography study [published online ahead of print, 2021 Jul 27]. Int Ophthalmol. 2021;1-10. doi:10.1007/s10792-021-01952-5.
• Referans19. Ornek K, Temel E, Asıkgarip N, Kocamıs O (2020) Localized retinal nerve fiber layer defect in patients with COVID-19. Arq Bras Oftalmol 83(6):562-3.
• Referans20. Santos SF, de Oliveira HL, Yamada ES, et al. The gut and Parkinson's Disease: a bidirectional pathway. Front Neurol 2019; 10: 574.
• Referans21. Aydin TS, Umit D, Nur OM, et al. Optical coherence tomography findings in Parkinson's disease. Kaohsiung J Med Sci 2018; 34(3): 166–171.
• Referans22. Satue M, Obis J, Alarcia R, et al. Retinal and choroidal changes in patients with Parkinson's disease detected by swept-source optical coherence tomography. Curr Eye Res 2018; 43(1): 109–115.
• Referans23. Garcia-Martin E, Larrosa JM, Polo V, et al. Distribution of retinal layer atrophy in patients with Parkinson's disease and association with disease severity and duration. Am J Ophthalmol 2014; 157(2): 470–478.e2.
• Referans24. Singh M, Khan RS, Dine K, et al. Intracranial inoculation is more potent than intranasal inoculation for inducing optic neuritis in the mouse hepatitis virus-induced model of multiple sclerosis. Front Cell Infect Microbiol 2018; 8: 311.