Occult Acute Macular Neuroretinopathy

Abstract

A 19-year-old Caucasian woman developed an upper respiratory infection, took a cold formulation containing 5 mg of phenylephrine, and developed a very rare and unusual form of acute macular neuroretinopathy (AMN) that could not be detected on fundoscopic examination, visual fields, nor electrophysiological testing. Spectral-domain optical coherence tomography (SD-OCT) revealed a lesion limited to the fovea. This case illustrates the value of SD-OCT, in light of otherwise normal testing, in a variant of AMN the authors call "occult AMN".

Sudden Fixed Swirl Circles in the Vision of a Young Healthy Woman

“…The clinical presentation is with flat, reddish, wedge-shaped or teardrop-shaped intraretinal lesions usually pointing toward the fovea and best seen using near-infrared reflectance imaging . These lesions may be very subtle, and fundus examination may be unremarkable, as in the present patient.…”

Acute Macular Neuroretinopathy

“…2 Findings on early OCT scans include a hyperreflective layer bordering the photoreceptor layers and the outer nuclear layer with backscatter at the outer plexiform layer. 6 Vaphiades observed similar findings where lesions had demonstrated focal thinning of the outer retina, potentially involving the photoreceptor outer segments with distortion of the junctions of the inner and outer segments. 6 Our patient had a classic presentation for AMN.…”

“…6 Vaphiades observed similar findings where lesions had demonstrated focal thinning of the outer retina, potentially involving the photoreceptor outer segments with distortion of the junctions of the inner and outer segments. 6 Our patient had a classic presentation for AMN. In the literature, there is a higher-reported prevalence in women, but symptom presentation regardless of gender was the most important criteria for diagnosing AMN.…”