Clinical and multimodal imaging features of acute macular neuroretinopahy associated with COVID-19_Chinese Journal of Ocular Fundus Diseases

Authors：

Wu Bin , Xie Shiyong , Kang Lei , Liu Yangchen , He Guanghui ,  Chen Song

Tianjin Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, Tianjin Institute of Ophthalmology, Tianjin 300020, China;

Corresponding?author：

Chen Song, Email: chensong9999@126.com

Keywords：

COVID-19; Acute macular neuroretinopathy; Multimodal imaging

DOI：

10.3760/cma.j.cn511434-20221231-00674

Video：

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Objective To observe the clinical and multimodal imaging characteristics of eyes with acute macular neuroretinopathy (AMN) associated with COVID-19. Methods A retrospective clinical study. From December 18 to 26, 2022, 16 eyes of 8 patients with AMN associated with COVID-19 were included in the study. There were 4 males and 4 females; all cases were bilateral. The age was (31.5±9.6) years old. The time from fever to decreased vision was (3.75±1.04) days. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundus microscopy, fundus color photography, and optical coherence tomography (OCT) were performed in all patients. Infrared fundus photography (IR), OCT angiography (OCTA) and fluorescein fundus angiography (FFA) were performed in 14, 6 and 4 eyes respectively. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for statistics. The clinical data, IR, OCT and OCTA imaging features of the patients were retrospectively analyzed. Results The logMAR BCVA of AMN eyes was 4.21±0.74, intraocular pressure was (14.87±1.50) mm Hg (1 mm Hg=0.133 kPa). Fundus color photography showed that multiple gray-white petal-shaped lesions were arranged around the macular fovea in 2 eyes; no obvious abnormality was found in the macular area in 14 eyes. Of the 14 eyes examined by IR, 6 eyes had irregular weak reflective lesions around the macular fovea. OCT showed strong reflex in the outer nuclear layer and outer plexiform layer of all eyes, including 15 eyes with elliptical zone injury. In 6 eyes examined by OCTA, the blood flow density of the superficial and deep capillary plexus (DCP) of retina decreased, and the blood flow density of DCP decreased significantly. The en-face image of DCP showed the wedge-shaped strong reflective lesion area with the tip pointing to the central fovea in 2 eyes. No abnormal fluorescence was observed in FFA. Conclusions The characteristic manifestation of AMN associated with COVID-19 is weak reflex focus in IR; OCT shows strong reflection in outer core layer and outer plexiform layer; OCTA showed that retinal DCP blood flow density decreased.

Citation： Wu Bin, Xie Shiyong, Kang Lei, Liu Yangchen, He Guanghui, Chen Song. Clinical and multimodal imaging features of acute macular neuroretinopahy associated with COVID-19. Chinese Journal of Ocular Fundus Diseases, 2023, 39(3): 223-226. doi: 10.3760/cma.j.cn511434-20221231-00674 Copy

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1. Bos PJ, Deutman AF. Acute macular neuroretinopathy[J]. Am J Ophthalmol, 1975, 80(4): 573-584. DOI: 10.1016/0002-9394(75)90387-6.
2. 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.
3. Ng XL, Betzler BK, Testi I, et al. Ocular adverse events after COVID-19 vaccination[J]. Ocul Immunol Inflamm, 2021, 29(6): 1216-1224. DOI: 10.1080/09273948.2021.1976221.
4. Marinho PM, Marcos AAA, Romano AC, et al. Retinal findings in patients with COVID-19[J/OL]. Lancet, 2020, 395(10237): 1610[2020-05-23]. https://doi.org/10.1016/S0140-6736(20)31014-X. DOI:10.1016/S0140-6736(20)31014-X.
5. Azar G, Bonnin S, Vasseur V, et al. Did the COVID-19 pandemic increase the incidence of acute macular neuroretinopathy?[J/OL]. J Clin Med, 2021, 10(21): 5038[2021-10-28]. https://doi.org/10.3390/jcm10215038. DOI: 10.3390/jcm10215038.
6. Jalink MB, Bronkhorst IHG. A sudden rise of patients with acute macular neuroretinopathy during the COVID-19 pandemic[J]. Case Rep Ophthalmol, 2022, 13(1): 96-103. DOI: 10.1159/000522080.
7. 滕巖, 滕羽菲. 急性黃斑區神經視網膜病變的臨床特征及病理機制研究進展[J]. 中華眼科雜志, 2019, 55(4): 311-315. DOI: 10.3760/cma.j.issn.0412-4081.2019.04.016.Ten Y, Ten YF. The clinical characteristics and pathologic mechanisms of acute macular neuroretinopathy[J]. Chin J Ophthalmol, 2019, 55(4): 311-315. DOI: 10.3760/cma.j.issn.0412-4081.2019.04.016.
8. 姜利斌, 魏文斌, 王光璐. 急性黃斑區神經視網膜病變[J]. 中國實用眼科雜志, 2006, 24(3): 240-243. DOI: 10.3760/cma.j.issn.1006-4443.2006.03.003.Jiang LB, Wei WB, Wang GL. Acute macular neuroretinopathy[J]. Chin J Pract Ophthalmol, 2006, 24(3): 240-243. DOI: 10.3760/cma.j.issn.1006-4443.2006.03.003.
9. Dinh RH, Tsui E, Wieder MS, et al. Acute macular neuroretinopathy and coronavirus disease 2019[J]. Ophthalmol Retina, 2023, 7(2): 198-200. DOI: 10.1016/j.oret.2022.09.005.
10. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19[J]. Thromb Res, 2020, 191: 145-147. DOI: 10.1016/j.thromres.2020.04.013.
11. Sampson DM, Alonso-Caneiro D, Chew AL, et al. Enhanced visualization of subtle outer retinal pathology by en-face optical coherence tomography and correlation with multi-modal imaging[J/OL]. PLoS One, 2016, 11(12): e0168275[2016-12-13]. https://doi.org/10.1371/journal.pone.0168275. DOI:10.1371/journal.pone.0168275.

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Clinical and multimodal imaging features of acute macular neuroretinopahy associated with COVID-19

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