Objective To observe the clinical and fundus imaging features of acute macular neuroretinopathy (AMN) associated with COVID-19. Methods A retrospective case study. A total of 32 eyes of 18 patients diagnosed of AMN associated with COVID-19 at Chengdu Aidi Eye Hospital from December 2022 to February 2023 were included. All patients had a history of fever 1 to 5 days prior to ocular onset and tested positive for SARS CoV-2 antigen. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, scanning laser ophthalmoscope (SLO), infrared fundus photography (IR), and optical coherence tomography (OCT); OCT angiography, visual field and multifocal electroretinogram (mf-ERG) were performed in 6 patients (11 eyes), 3 patients (6 eyes) and 1 patient (2 eyes), respectively. Follow-up time was 8-10 weeks. The clinical and fundus imaging features were observed and analyzed.Results There were 6 males (12 eyes) and 12 females (20 eyes), aged from 15 to 36 years, with the mean age of (28.00±5.86) years. Fourteen patients were bilateral and 4 patients were unilateral. The time from the onset of eye symptoms to seeing a doctor was ranged from 1 day to 8 weeks. Among them, 6 patients (10 eyes) visited the doctor within 3 days of onset, while 12 patients (22 eyes) visited the doctor after 3 days of onset. The BCVA was 0.80±0.29. Fundus color photography and SLO examination showed that only 2 patients (4 eyes) showed sheet or petal-like dark red lesions in the macular area, and no obvious abnormal changes were observed in other patients. No obvious abnormalities were found in AF examination of all patients. IR examination showed no significant abnormality in 6 cases which came to hospital within 3 days after the onset, but irregular hyporeflective dark shadow lesions in the macular region of patients with more than 3-day course of disease was observed. OCT examinations of all eyes showed hyperreflective band or patchy lesion on the outer plexiform layer (OPL) and outer nuclear layer (ONL) and affect the ellipsoid zone (EZ) and interdigitation zone (IZ). In 11 eyes of 6 patients undergoing OCTA examination, the blood flow density of the choroidal capillary layer in the focal area decreased. In 6 eyes of 3 patients who underwent visual field examination, the physiologic scotoma was slightly enlarged. One patient (2 eyes) receiving mf-ERG showed a concave reduction in macular center amplitude. The hyperreflective band lesion on OPL and ONL disappear rapidly within 2 weeks, while the continuity of EZ recovered slowly, and the disruption of IZ kept existing for more than 10 weeks. Conclusions Most AMN associated with COVID-19 are young women; IR showed irregular weak reflex in the lesion area. OCT showed strong OPL and ONL reflection. OCTA was characterized by decreased blood flow density in the choroidal capillary layer of the focal area.
Citation：
Xiong Feng, Shuai Na, Zhou Shu, Liu Hua, Zhou Bo. Clinical and fundus imaging features of acute macular neuroretinopathy associated with COVID-19. Chinese Journal of Ocular Fundus Diseases, 2023, 39(3): 214-217. doi: 10.3760/cma.j.cn511434-20230103-00675
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Copyright © the editorial department of Chinese Journal of Ocular Fundus Diseases of West China Medical Publisher. All rights reserved
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- 1. Azar G, Bonnin S, Vasseur V, et al. Did the COVID-19 pandemic increase the incidence of acute macular neuroretinopathy?[J]. J Clin Med, 2021, 10(21): 5038. DOI: 10.3390/jcm10215038.
- 2. Capuano V, Forte P, Sacconi R, et al. Acute macular neuroretinopathy as the first stage of SARS-CoV-2 infection[J/OL]. Eur J Ophthalmol, 2022, 2022: 11206721221090697[2022-03-31]. https://europepmc.org/article/MED/35360952. DOI: 10.1177/11206721221090697. [published online ahead of print].
- 3. David JA, Fivgas GD. Acute macular neuroretinopathy associated with COVID-19 infection[J/OL]. Am J Ophthalmol Case Rep, 2021, 24: 101232[2021-11-10]. https://linkinghub.elsevier.com/retrieve/pii/S2451-9936(21)00241-3. DOI: 10.1016/j.ajoc.2021.101232.
- 4. Bos PJ, Deutman AF. Acute macular neuroretinopathy[J]. Am J Ophthalmol, 1975, 80(4): 573-584. DOI: 10.1016/0002-9394(75)90387-6.
- 5. Bhavsar KV, Lin S, Rahimy E, et al. Acute macular neuroretinopathy: a comprehensive review of the literature[J]. Surv Ophthalmol, 2016, 61(5): 538-565. DOI: 10.1016/j.survophthal.2016.03.003.
- 6. Hashimoto Y, Saito W, Mori S, et al. Increased macular choroidal blood flow velocity during systemic corticosteroid therapy in a patient with acute macular neuroretinopathy[J]. Clin Ophthalmol, 2012, 6: 1645-1649. DOI: 10.2147/OPTH.S35854.
- 7. Lee SY, Cheng JL, Gehrs KM, et al. Choroidal features of acute macular neuroretinopathy via optical coherence tomography angiography and correlation with serial multimodal imaging[J]. JAMA Ophthalmol, 2017, 135(11): 1177-1183. DOI: 10.1001/jamaophthalmol.2017.3790.
- 8. Liu JC, Nesper PL, Fawzi AA, et al. Acute macular neuroretinopathy associated with influenza vaccination with decreased flow at the deep capillary plexus on OCT angiography[J]. Am J Ophthalmol Case Rep, 2018, 10: 96-100. DOI: 10.1016/j.ajoc.2018.02.008.
- 9. Hanff TC, Mohareb AM, Giri J, et al. Thrombosis in COVID-19[J]. Am J Hematol, 2020, 95(12): 1578-1589. DOI: 10.1002/ajh.25982.
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