ObjectiveTo observe the multimodal imaging features of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsA 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. ResultsThe 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. ConclusionThe 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.