Multimodal imaging features of acute macular neuroretinopathy associated with COVID-19_Chinese Journal of Ocular Fundus Diseases

Authors：

 Zhang Shujun , Lyu Aiguo , Wang Yanna

Handan Eye Hospital (The Third Hospital of Handan), Handan 056006, China;

Corresponding author：

Zhang Shujun, Email: handanzsj@163.com

Keywords：

COVID-19; Acute macular neuroretinopathy; Multimodal imaging

DOI：

10.3760/cma.j.cn511434-20221223-00669

Video：

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Objective To observe the multimodal imaging features of acute macular neuroretinopathy (AMN) associated with COVID-19. Methods A retrospective case study. A total of 52 eyes of 26 patients of AMN associated with COVID-19 diagnosed in Handan Eye Hospital from December 8 to 20, 2022 were included in the study. There were 8 males and 18 females, with the mean age of (33.8±8.1) years. All the patients were bilateral. The time from diagnosis of COVID-19 to the onset of vision loss was 3 to 6 days. All patients underwent the examinations of best corrected visual acuity (BCVA), fundus color photography, infrared fundus photography (IR), fundus autofluorescence (AF), and optical coherence tomography (OCT). Fluorescein fundus angiography (FFA) combined with indoxine green angiography (ICGA) were performed in 12 eyes, and visual field were performed in 18 eyes. Multimodal image features of the affected eye were retrospectively analyzed. Results The BCVA of the affected eye was 0.25 to 1.0. Round or mottled grayish-white lesions in the macular area were seen in all affected eyes. IR examination showed irregular map-like weak reflex in macular region. AF examination showed speckled fluorescence enhancement in lesion related areas in 3 eyes. FFA combined with ICGA showed weak fluorescence in the macular region in 8 eyes. OCT examination showed patchy strong reflection in the outer plexus layer (OPL) and outer nuclear layer (ONL) of macular area in all affected eyes, and partial absence of outer membrane and ellipsoid band. The en-face OCT showed petal-like intense refleciton between OPL and ONL. Eighteen eyes underwent visual field, and 15 eyes had central dark spots. Conclusion The characteristic manifestations of AMN associated with COVID-19 are speckled or round-like grayish-white lesions in the macular area, weak reflexes in IR, enhanced OPL and ONL reflexes in OCT, and petal-like intense refleciton changes between OPL and ONL can be seen in en-face OCT.

Citation： Zhang Shujun, Lyu Aiguo, Wang Yanna. Multimodal imaging features of acute macular neuroretinopathy associated with COVID-19. Chinese Journal of Ocular Fundus Diseases, 2023, 39(3): 204-207. doi: 10.3760/cma.j.cn511434-20221223-00669 Copy

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13.	Rahimy E, Sarraf D. Paracentral acute middle maculopathy spectral-domain optical coherence tomography feature of deep capillary ischemia[J]. Curr Opin Ophthalmol, 2014, 25(3): 207-212. DOI: 10.1097/ICU.0000000000000045.
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1. Gregorczyk M, Roskal-Wałek J. Ocular symptoms in SARS-CoV-2 infection[J]. Pol Merkur Lekarski, 2022, 50(296): 86-93.
2. 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://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577875/pdf/main.pdf. DOI: 10.1016/j.ajoc.2021.101232.
3. Pastore MR, Furlanis G, Tognetto D. Bilateral Purtscher-like retinopathy associated with SARS-CoV-2 infection[J/OL]. JAMA Ophthalmol, 2022, 140(2): e214979[2022-02-17]. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2789254. DOI: 10.1001/jamaophthalmol.2021.4979.
4. 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.
5. Ye Z, Zhang Y, Wang Y, et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review[J]. Eur Radiol, 2020, 30(8): 4381-4389. DOI: 10.1007/s00330-020-06801-0.
6. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19)[J]. JAMA Cardiol, 2020, 5(7): 819-824. DOI: 10.1001/jamacardio.2020.1096.
7. Kariyawasam JC, Jayarajah U, Riza R, et al. Gastrointestinal manifestations in COVID-19[J]. Trans R Soc Trop Med Hyg, 2021, 115(12): 1362-1388. DOI:10.1093/trstmh/trab042.
8. Marsiglia M, Chwalisz BK, Maher M. Neuroradiologic imaging of neurologic and neuro-ophthalmic complications of coronavirus-19 infection[J]. J Neuroophthalmol, 2021, 41(4): 452-460. DOI: 10.1097/WNO.0000000000001454.
9. D'Alessandro E, Kawasaki A, Eandi CM. Pathogenesis of vascular retinal manifestations in COVID-19 patients: a review[J/OL]. Biomedicines, 2022, 10(11): 2710[2022-10-26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9687698/pdf/biomedicines-10-02710.pdf. DOI: 10.3390/biomedicines10112710.
10. de Souza EC, de Campos VE, Duker JS. Atypical unilateral multifocal choroiditis in a COVID-19 positive patient[J/OL]. Am J Ophthalmol Case Rep, 2021, 22: 101034[2021-02-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893242/pdf/main.pdf. DOI: 10.1016/j.ajoc.2021.101034.
11. D'Souza HS, Tailor PD, Olsen TW. Seeing blue dots after COVID-19 infection[J]. JAMA Ophthalmol, 2023, 141(1): 97-98. DOI: 10.1001/jamaophthalmol.2022.5235.
12. 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.
13. Rahimy E, Sarraf D. Paracentral acute middle maculopathy spectral-domain optical coherence tomography feature of deep capillary ischemia[J]. Curr Opin Ophthalmol, 2014, 25(3): 207-212. DOI: 10.1097/ICU.0000000000000045.
14. Marinho PM, Marcos AAA, Branco AMC, et al. Retinal autofluorescence findings after COVID-19[J/OL]. Int J Retina Vitreous, 2021, 7(1): 71[2021-11-27]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626712/pdf/40942_2021_Article_341.pdf. DOI: 10.1186/s40942-021-00341-5.
15. Pirraglia MP, Ceccarelli G, Cerini A, et al. Retinal involvement and ocular findings in COVID-19 pneumonia patients[J/OL]. Sci Rep, 2020, 10(1): 17419[2020-10-15]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566835/pdf/41598_2020_Article_74446.pdf. DOI: 10.1038/s41598-020-74446-6.
16. Sim R, Cheung G, Ting D, et al. Retinal microvascular signs in COVID-19[J]. Br J Ophthalmol, 2022, 106(9): 1308-1312. DOI: 10.1136/bjophthalmol-2020-318236.
17. Pereira LA, Soares LCM, Nascimento PA, et al. Retinal findings in hospitalised patients with severe COVID-19[J]. Br J Ophthalmol, 2022, 106(1): 102-105. DOI: 10.1136/bjophthalmol-2020-317576.

Chinese Journal of Ocular Fundus Diseases

Multimodal imaging features of acute macular neuroretinopathy associated with COVID-19

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