Acute Macular Neuroretinopathy and Coronavirus Disease 2019

Dinh, Russel H.; Tsui, Edmund; Steinberg, Yael; Barash, Alexander; Park, Michael M.; Rahimy, Ehsan; Mruthyunjaya, Prithvi; Lu, Louise J.; Michalak, Suzanne M.; Shah, Rohan J.; Sierpina, David; Winter, Timothy W.; Shields, Rob; Uchiyama, Eduardo; Lee, Gregory D.; Komati, Rahul; Lee, Eric; Kasi, Sundeep; Brian, K.

doi:10.1016/j.oret.2022.09.005

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…Three notable articles outline their experiences with AMN in patients who had COVID-19 or the COVID-19 vaccination. 5 , 9 , 10 Similar to these cases, our patients had similar findings on examination and testing as outlined in the literature. However, our patients presented with AMN after several weeks (patient A) or after multiple confirmed cases of COVID throughout the course of 2 years.…”

Section: Literature Analysissupporting

confidence: 86%

COVID-19 Related Acute Macular Neuroretinopathy (AMN): A Case Series

Vu,

Schillerstrom,

Mancha

et al. 2023

IMCRJ

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Purpose Following the emergence of coronavirus disease 2019 (COVID-19) eye care practitioners have become accustomed to identifying and managing an array of ocular complications following the viral infection. Acute macular neuroretinopathy (AMN) is one such complication that has been reported. While the etiology of AMN has eluded researchers, current literature is suggestive of a microvascular compromise within the deep capillary plexus of the retina. Observations In this case series, we aim to explore two individual cases of presumed AMN following confirmed COVID-19 infection. Our observations and findings support the diagnosis of AMN following the criteria outlined in literature. Conclusion and Importance Although acute macular neuroretinopathy is rare, it should be considered by clinicians when considering diagnosis. With the changing landscape of the pandemic, careful and thorough history and testing are key in the diagnosis of AMN.

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Section: Literature Analysissupporting

confidence: 86%

COVID-19 Related Acute Macular Neuroretinopathy (AMN): A Case Series

Vu,

Schillerstrom,

Mancha

et al. 2023

IMCRJ

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“…The study showed that a study of AMN in 156 eyes found that 54% of cases were bilateral [2] . In contrast, after the SARS-CoV-2 pandemic, the prevalence of AMN in patients with SARS-CoV-2 combined with AMN was 67% (10/15) in both eyes, with a higher prevalence of AMN in both eyes [23] . All cases in this study had bilateral disease, which is consistent with the findings of the above-mentioned study, suggesting that after infection with SARS-CoV-2, if AMN occurs, the likelihood of bilateral disease is high.…”

Section: Acute Macular Neuroretinopathy Following Sars-cov-2 Infectionmentioning

confidence: 83%

Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection

Liu¹,

Wang²,

Chen³

2023

Int J Ophthalmol

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AIM: To describe the clinical characteristics of eyes using multimodal imaging features with acute macular neuroretinopathy (AMN) lesions following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Retrospective case series study. From December 18, 2022 to February 14, 2023, previously healthy cases within 1-week infection with SARS-CoV-2 and examined at Tianjin Eye Hospital to confirm the diagnosis of AMN were included in the study. Totally 5 males and 9 females [mean age: 29.93±10.32 (16-49)y] were presented for reduced vision, with or without blurred vision. All patients underwent best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundoscopy. Simultaneously, multimodal imagings fundus photography (45° or 200° field of view) was performed in 7 cases (14 eyes). Near infrared (NIR) fundus photography was performed in 9 cases (18 eyes), optical coherence tomography (OCT) in 5 cases (10 eyes), optical coherence tomography angiography (OCTA) in 9 cases (18 eyes), and fundus fluorescence angiography (FFA) in 3 cases (6 eyes). Visual field was performed in 1 case (2 eyes). RESULTS: Multimodal imaging findings data from 14 patients with AMN were reviewed. All eyes demonstrated different extent hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT or OCTA. Fundus photography (45° or 200° field of view) showed irregular hypo-reflective lesion around the fovea in 7 cases (14 eyes). OCTA demonstrated that the superficial retinal capillary plexus (SCP) vascular density, deep capillary plexus (DCP) vascular density and choriocapillaris (CC) vascular density was reduced in 9 case (18 eyes). Among the follow-up cases (2 cases), vascular density increased in 1 case with elevated BCVA; another case has vascular density decrease in one eye and basically unchanged in other eye. En face images of the ellipsoidal zone and interdigitation zone injury showed a low wedge-shaped reflection contour appearance. NIR image mainly show the absence of the outer retinal interdigitation zone in AMN. No abnormal fluorescence was observed in FFA. Corresponding partial defect of the visual field were visualized via perimeter in one case. CONCLUSION: The morbidity of SARS-CoV-2 infection with AMN is increased. Ophthalmologists should be aware of the possible, albeit rare, AMN after SARS-CoV-2 infection and focus on multimodal imaging features. OCT, OCTA, and infrared fundus phase are proved to be valuable tools for detection of AMN in patients with SARS-CoV-2.

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“…However, OCTA changes are not always detected. In Dinh RH’s case series, only half of the patients on whom OCTA was performed had positive flow voids in the deep capillary plexus or choriocapillaris [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

The characteristics of acute macular neuroretinopathy following COVID-19 infection

Feng,

Zhao,

et al. 2024

BMC Ophthalmol

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Background In this study, we report a case series of acute macular neuroretinopathy (AMN) associated with COVID-19 infection. Methods This retrospective observational study was conducted at Beijing Tongren Hospital. We reviewed patients who were diagnosed with AMN within one month of testing positive for COVID-19 using real-time reverse transcription-polymerase chain reaction (RT-PCR). Results A total of 11 AMN patients (20 eyes) were included in the study. The mean age was 33.8 ± 12.6 years. The average interval between a positive COVID-19 PCR test and the onset of ocular symptoms was 2.8 ± 2.5 days. The mean follow-up period for the patients was 12.5 ± 3.8 weeks. Imaging characteristics of AMN patients following COVID-19 infection included areas of low reflectivity on near-infrared reflectance (NIR) imaging, hyperreflective lesions at the level of the outer plexiform layer (OPL) and outer nuclear layer (ONL) and disruption of the ellipsoid zone (EZ) on spectral domain optical coherence tomography (SD-OCT) B-scans. Visual field examinations revealed parafoveal scotomas that closely corresponded to the clinical lesions. Optical coherence tomography angiography (OCT-A) demonstrated impaired perfusion in the deep retinal vascular plexus. Fluorescein angiography (FA), indocyanine green angiography (ICGA), and spontaneous fundus autofluorescence showed no significant abnormalities. During follow-up, partial improvement in retinal lesions was observed in NIR imaging and SD-OCT in some patients, but a proportion of patients still exhibited persistent retinal damage and no improvement in visual field scotomas. Conclusion COVID-19-related AMN share similar clinical and imaging features with AMN due to other causes, as evidenced by the persistent presence of visual field scotomas over a longer duration. Trail registration https://www.chictr.org.cn/; identifier: ChiCTR2100044365

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Acute Macular Neuroretinopathy and Coronavirus Disease 2019

Cited by 13 publications

References 14 publications

COVID-19 Related Acute Macular Neuroretinopathy (AMN): A Case Series

COVID-19 Related Acute Macular Neuroretinopathy (AMN): A Case Series

Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection

The characteristics of acute macular neuroretinopathy following COVID-19 infection

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