Исследование микрососудистого русла сетчатки и зрительного нерва методом оптической когерентной томографии-ангиографии у пациентов, перенесших COVID-19

Введение. Признаки ангиоретинопатии выявляются у 7–27,7 % пациентов, перенесших COVID-19. Прижизненную оценку микроциркуляторных изменений сетчатки у таких пациентов позволяет дать методика оптической когерентной томографии-ангиографии (ОКТА). Цель – изучение и сравнение основных показателей микроциркуляции капиллярных сплетений сетчатки и диска зрительного нерва с применением ОКТА у пациентов, перенесших COVID-19 разной степени тяжести. Материалы и методы. Основную группу составили 54 человека (108 глаз), перенесших COVID-19 в течение предшествующих 3 месяцев. В зависимости от тяжести течения COVID-19 пациенты были разделены на 3 подгруппы. Контрольную группу составили 22 здоровых добровольца (44 глаза). Всем пациентам проводилось стандартное офтальмологическое обследование, включая ОКТА. Оценивали плотность сосудов (VD) в целом и по секторам в пределах поверхностного (SCP) и глубокого (DCP) капиллярных сплетений, радиальных перипапиллярных капилляров (RPC) и в области фовеальной аваскулярной зоны (FAZ). Результаты. По всем исследованным показателям не выявлено значимых различий между пациентами контрольной группы и подгруппы пациентов с легким течением COVID-19. У пациентов со среднетяжелым течением COVID-19 выявлено значимое снижение VD SCP (P<0,01) и VD RPC (P<0,01). У пациентов с тяжелым и крайнетяжелым течением заболевания наблюдалось снижение VD DCP в области фовеа (P=0,016) и VD FAZ (P<0,01). Показатели VD коррелируют с толщиной слоев сетчатки, в которых эти сосудистые сплетения залегают. Ни в одной из подгрупп не наблюдалось статистически значимого расширения площади FAZ и структурных изменений диска зрительного нерва. Заключение. У пациентов, перенесших COVID-19, имеются признаки редукции капиллярного кровотока сетчатки в SCP и RPC, пропорциональные тяжести COVID-19. Ассоциированная микроангиопатия является значимым офтальмологическим проявлением COVID-19. Микросудистые изменения сетчатки могут выступать в роли нового биомаркера, отражающего тяжесть возникающего при COVID-19 поражения сосудистой системы организма.

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