Acute Macular Neuroretinopathy Research Articles

The Characteristics of White Dot Syndromes Following SARS-COV-2 Infection: A Systematic Review.

To review all studies reporting the occurrence of white dot syndromes (WDSs) following SARS-COV-2 infection. On May 12, 2023, we registered our protocol on PROSPERO [registration number: CRD42023426012]. Five different databases including PubMed, Scopus, Web of Science, Google Scholar, and Science Direct were searched up to May 2023. We included all studies that reported the symptoms of WDSs following SARS-COV-2 infection. The data was extracted using a uniform Excel extraction sheet. All statistical tests were conducted with a 95% confidence interval and a 5% error margin. A p-value of less than 0.05 was considered statistically significant. The publication bias of included studies was assessed using JBI Critical Appraisal Checklist for Case Reports and IHE Quality Appraisal Checklist for Case Series studies. This review included thirty-two studies involving forty-eight patients. Acute macular neuroretinopathy was the most common disease (70.8%) followed by multiple evanescent white dot syndrome (14.6%) with 58.3% of WDS after their first SARS-COV-2 infection, and paracentral acute middle maculopathy (4.1%). They were mostly unilateral (56.2%). The presenting symptoms were blurred vision (70.8%), visual field disturbance (68.7%), and photopsia (20.8%). About 35.4% of the patients improved by their treatment and future complications were persistent scotoma (4.2%) and macular edema (2.1%). White dot syndromes are very rare entities. Our findings suggest a possible association between white dot syndrome onset and SARS-COV-2 infection. We recommend ophthalmologists should be aware of this suggested association to deliver better management and patients' care.

Safety analysis of Oseltamivir and Baloxavir Marboxil after market approval: a pharmacovigilance study based on the FDA adverse event reporting system

Background and objectivesAmidst limited influenza treatment options, evaluating the safety of Oseltamivir and Baloxavir Marboxil is crucial, particularly given their comparable efficacy. This study investigates post-market safety profiles, exploring adverse events (AEs) and their drug associations to provide essential clinical references.MethodsA meticulous analysis of FDA Adverse Event Reporting System (FAERS) data spanning the first quarter of 2004 to the fourth quarter of 2022 was conducted. Using data mining techniques like reporting odds ratio (ROR), proportional reporting ratio, Bayesian Confidence Propagation Neural Network, and Multiple Gamma Poisson Shrinkage, AEs related to Oseltamivir and Baloxavir Marboxil were examined. Venn analysis compared and selected specific AEs associated with each drug.ResultsIncorporating 15,104 Oseltamivir cases and 1,594 Baloxavir Marboxil cases, Wain analysis unveiled 21 common AEs across neurological, psychiatric, gastrointestinal, dermatological, respiratory, and infectious domains. Oseltamivir exhibited 221 significantly specific AEs, including appendicolith [ROR (95% CI), 459.53 (340.88 ∼ 619.47)], acne infantile [ROR (95% CI, 368.65 (118.89 ∼ 1143.09)], acute macular neuroretinopathy [ROR (95% CI), 294.92 (97.88 ∼ 888.64)], proctitis [ROR (95% CI), 245.74 (101.47 ∼ 595.31)], and Purpura senile [ROR (95% CI), 154.02 (81.96 ∼ 289.43)]. designated adverse events (DMEs) associated with Oseltamivir included fulminant hepatitis [ROR (95% CI), 12.12 (8.30-17.72), n=27], ventricular fibrillation [ROR (95% CI), 7.68 (6.01–9.83), n=64], toxic epidermal necrolysis [ROR (95% CI), 7.21 (5.74–9.05), n=75]. Baloxavir Marboxil exhibited 34 specific AEs, including Melaena [ROR (95% CI), 21.34 (14.15–32.18), n = 23], cystitis haemorrhagic [ROR (95% CI), 20.22 (7.57-54.00), n = 4], ileus paralytic [ROR (95% CI), 18.57 (5.98–57.71), n = 3], and haemorrhagic diathesis [ROR (95% CI), 16.86 (5.43–52.40)), n = 3]. DMEs associated with Baloxavir Marboxil included rhabdomyolysis [ROR (95% CI), 15.50 (10.53 ∼ 22.80), n = 26].ConclusionMonitoring fulminant hepatitis during Oseltamivir treatment, especially in patients with liver-related diseases, is crucial. Oseltamivir’s potential to induce abnormal behavior, especially in adolescents, necessitates special attention. Baloxavir Marboxil, with lower hepatic toxicity, emerges as a potential alternative for patients with liver diseases. During Baloxavir Marboxil treatment, focused attention on the occurrence of rhabdomyolysis is advised, necessitating timely monitoring of relevant indicators for those with clinical manifestations. The comprehensive data aims to provide valuable insights for clinicians and healthcare practitioners, facilitating an understanding of the safety profiles of these influenza treatments in real-world scenarios.

Acute Macular Neuroretinopathy Following Moderna mRNA COVID-19 Vaccination

Purpose: We report a case of acute macular neuroretinopathy (AMN) following and then exacerbated by mRNA COVID-19 booster vaccination. Methods: Report of a case Observations: A 79-year-old Caucasian male presented with a central scotoma in the right eye 2 weeks following administration of his second mRNA COVID-19 vaccination. Optical coherence tomography, fundus autofluorescence and color photography, fluorescein, ICG, and clinical findings were consistent with a diagnosis of AMN. Anatomy and symptoms worsened 8 months later, approximately 2 weeks after the third mRNA COVID-19 vaccine. Improvement in symptoms and findings occurred without therapy 15 months post-presentation. Discussion: This post-COVID vaccine AMN case is reported following an mRNA vaccine. The chronological relationship to both vaccines, exacerbation after the third vaccine, and occurrence in an older male without the recognized risk factors for non-vaccine-related AMN are compelling for possible causality. Depending on the patient’s health and the state of the COVID pandemic with regard to public health, should AMN occur soon after COVID vaccination, clinicians may consider foregoing additional vaccination/boosters or switching to an alternate COVID vaccine vector.

Acute Macular Neuroretinopathy After COVID-19 Infection in a Patient With Multiple Sclerosis.

Acute Macular Neuroretinopathy After COVID-19 Infection in a Patient With Multiple Sclerosis.

Optical coherence tomography angiography suggests choriocapillaris perfusion deficit as etiology of acute macular neuroretinopathy.

Acute macular neuroretinopathy (AMN) can cause sudden-onset and permanent scotoma in healthy young patients. Analysis of optical coherence tomography (OCT) and OCT angiography (OCTA) of AMN patients may provide insights into disease mechanism. We conducted a retrospective study of consecutive SARS-Cov-2-related AMN patients that presented in our clinic between Jan 1st, 2022, and April 30th, 2023, within 30days of symptom onset. Retinal vessel area density (VAD) of AMN lesions in OCTA was quantified and compared to an adjacent tissue control (ATC). This quantification was performed for the superficial vascular plexus (SVP), the intermediate capillary plexus (ICP), the deep capillary plexus (DCP), the choriocapillaris (CC), and choroid. Furthermore, en face OCT images were analyzed. Nine AMN patients were identified, 6 of these (4 female, 2 male, average age 25years) fulfilled the inclusion criteria and were included into this study. Average time from symptom onset to OCTA was 14.3days. No VAD differences between AMN and adjacent tissue were found in either retinal layer (SVP, ICP, DCP). In contrast, VAD in CC was reduced by 27% against the ATC (p = 0.007) and choroidal VAD was reduced by 41% (p = 0.017). Further analysis of en face OCT could show that the pathognomonic infrared hyporeflectivity in AMN is caused by photoreceptor alterations rather than changes in the inner retinal layers. Our data suggests that a perfusion deficit in the choroidal layers is responsible for AMN rather than in the DCP, which is the predominant hypothesis in current literature.

Purtscher-like Retinopathy and Acute Macular Neuroretinopathy in a Child with Acute Influenza A.

Purtscher-like Retinopathy and Acute Macular Neuroretinopathy in a Child with Acute Influenza A.

COVID-19 as a Potential Risk Factor for Acute Macular Neuroretinopathy.

COVID-19 as a Potential Risk Factor for Acute Macular Neuroretinopathy.

Clinical features of three-layer’s impairment of capillary plexuses’ perfusion at follow-up in patients with Purcher retinopathy and Purcher-like retinopathy

In Purcher retinopathy and Purcher-like retinopathy, ischemic lesions occur at the level of all three retina capillary plexuses. Recognition of characteristic ischemic patterns by optical coherence tomography helps to predict the degree of visual functions’ recovery. The aim of this study is to present clinical cases of patients with Purcher retinopathy and Purcher-like retinopathy and to observe the dynamics of visual rehabilitation of patients with retinal vascular conditions. Two patients with complaints of central vision loss and skotomata in the visual field were examined. The complex of multimodal visualization included fundus photoregistration with fundus camera, optical coherence tomography and optical coherence tomography-angiography, and microperimetry. Paracentral acute middle maculopathy and acute macular neuroretinopathy are the manifestations of the same ischemic process on different levels of retinal vascular plexuses. The “diffuse” pattern damages in paracentral acute middle maculopathy lead to more permanent structural and functional impairments opposed to the “skip” pattern. The optical coherence tomography allows to predict the possibilities of visual and functional rehabilitation in patients with ischemic damage of retinal vessels.

The characteristics of acute macular neuroretinopathy following COVID-19 infection

BackgroundIn this study, we report a case series of acute macular neuroretinopathy (AMN) associated with COVID-19 infection.MethodsThis 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).ResultsA 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.ConclusionCOVID-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 registrationhttps://www.chictr.org.cn/; identifier: ChiCTR2100044365

Association of acute macular neuroretinopathy with acute optic neuritis following COVID-19 infection

Acute optic neuritis is characterized by thinning of the inner retinal layers on optical coherence tomography. Acute macular neuroretinopathy is an outer retinal disorder that leads to thinning of the outer nuclear layer. A 34-year-old woman experienced decreased bilateral visual acuity 1 day following the coronavirus disease 2019 infection. Brain magnetic resonance imaging and demyelination testing revealed mild-to-moderate uneven enhancement of bilateral optic nerve segments, with anti-mog antibody reactivity. Hormone therapy was initiated, which led to outer nuclear layer thinning, completion of the ellipsoid zone, and an absent chimeric zone. The patient’s vision had been fully restored at her 1-year follow-up.

Acute Macular Neuroretinopathy after SARS-CoV-2 Infection: An Analysis of Clinical and Multimodal Imaging Characteristics.

This study aimed to analyze clinical and multimodal imaging characteristics of acute macular neuroretinopathy (AMN) post-recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Retrospective observational study. Medical records and multimodal imaging of 12 AMN eyes of eight patients (six female and two male) with recent SARS-CoV-2 infection were retrospectively analyzed. Four patients (50%) presented with bilateral AMN. Fundus ophthalmoscopy revealed a reddish-brown lesion around the macula, and two eyes had cotton-wool spots at the posterior pole. Three eyes showed mild hypo-autofluorescence. All FFA images (7 eyes) showed no abnormal signs. On OCT scans, all eyes showed outer nuclear layer (ONL) thinning, 8 eyes (66.7%) showed ONL hyperreflectivity, 5 eyes (41.7%) showed outer plexiform layer (OPL) hyperreflectivity, 8 eyes (66.7%) showed interdigitation zone (IZ) disruption, 11 eyes (91.6%) showed ellipsoid zone (EZ) disruption, 2 eyes (16.7%) showed cotton-wool spots and inner plexiform layer (IPL) hyperreflectivity, 1 eye (8.3%) had intraretinal cyst and 1 eye (8.3%) had inner nuclear layer (INL) thinning. Persistent scotoma, ONL hyperreflectivity and IZ/EZ disruption as well as recovery of OPL hyperreflectivity were reported after follow-up in three cases. AMN post-SARS-CoV-2 mostly affected young females and could present unilaterally or bilaterally. Dark lesions on IR reflectance and outer retinal hyperreflectivity on OCT are useful in diagnosing AMN. OPL/ONL hyperreflectivity on OCT could disappear after follow-up, but ONL thinning and IZ/EZ could persist.

29 Acute macular neuroretinopathy: A rare complication of primary dengue fever infection

29 Acute macular neuroretinopathy: A rare complication of primary dengue fever infection

Acute Macular Neuroretinopathy after Coronavirus Disease 2019 Infection: Clinical Characteristics and Associated Factors

Objective or PurposeAcute macular neuroretinopathy (AMN) is a rare, poorly understood retinal disease that affects the outer retina. Recent studies reported the onset of AMN is associated with COVID-19 infection. However, it still lacks thorough evaluation regarding the clinical features of AMN after COVID-19 infection. DesignRetrospective cohort study. ParticipantsThis study involved online registration of patients who were diagnosed with AMN after rapid antigen or PCR tests confirmed COVID-19 infections from December 2022 to March 2023. MethodsWe interviewed all patients and completed an evaluation survey that recorded age, sex, menstruation pattern, medical history, doses of COVID-19 vaccination, symptom onset (days after fever onset), symptoms, and treatment measures. The association between clinical characteristics and baseline visual acuity was investigated. Main Outcome MeasuresDemographic and clinical characteristics of AMN after COVID-19 infection. ResultsA total of 116 eyes from 66 patients were included in the present study. The average age was 30.4 ± 6.7, and 81.8% of patients were female. The average time of ocular symptom onset was 2.62 ± 1.88 days after fever onset. Scotomas (87.9%) were the most common symptoms reported by patients, whereas 25.9% and 1.7% of eyes had blurry vision and photopsia. 80.2%, 60.3%, 26.7%, 10.3%, and 3.4% of eyes showed ellipsoid zone (EZ) disruption, hyper-reflectivity of outer nuclear layer (ONL), hyper-reflectivity of Henle layer, hyper-reflectivity of outer plexiform layer (OPL), and macular edema, respectively. A history of smoking (Coef. =0.12, 95%CI: [0.00, 0.24]), macular edema (Coef. =0.14, 95%CI: [0.00, 0.88]), hyper-reflectivity of OPL (Coef. =0.16, 95%CI: [0.08, 0.24]), hyper-reflectivity of Henle layer (Coef. =0.08, 95%CI: [0.03, 0.14]), and EZ disruption (Coef. =0.07, 95%CI: [0.00, 0.13]) were associated with worse LogMAR visual acuity at baseline. Conclusions and RelevanceAMN after COVID-19 infection is more common in young females. Hyper-reflectivity of ONL and EZ disruption are the most common OCT features of AMN. Macular edema, hyper-reflectivity of OPL, hyper-reflectivity of the Henle layer, EZ disruption, and a history of smoking are associated with worse visual acuity at baseline.

OA06 Behçet's associated myositis: an unusual cause of exercise-induced leg pain

Abstract Introduction This case describes a 29-year-old gentleman of Cypriot heritage who presented with exercise-induced bilateral lower leg pain and swelling which made it difficult for him to cycle. Symptoms progressed over months to calf pain at rest accompanied by fatigue. He subsequently presented with central visual loss in the right eye, followed by the left. The second episode of visual loss coincided with development of oro-genital ulceration and, following rheumatology review, a diagnosis of Behçet’s disease was made. The case is significant in terms of the chronicity and nature of presenting symptoms which is not typically described in this disease. Case description A 29-year-old gentleman presented with exercise-induced bilateral lower leg pain and swelling for which he was reviewed in emergency care on four occasions. He received treatment for presumed cellulitis and underwent US-doppler studies, excluding thromboembolic disease. MRI of the lower legs was requested given lack of diagnosis with ongoing symptoms. This demonstrated bilateral muscle oedema in the antero-lateral compartments and lateral gastrocnemius heads, prompting rheumatology referral. Prior to attending rheumatology, the patient developed bilateral sequential visual loss. This was attributed to right acute macular neuroretinopathy, followed by significant left posterior pole choroidal ischaemia 2 months later. Each presentation was associated with transient low-grade anterior uveitis, vitritis, and the presence of a pre-papillary vitreous infiltrate. Initial treatment included a six-week oral prednisolone taper from 60mg daily. He reported a progressive leg pain which initially occurred during cycling but later affecting his walking. He was of Cypriot heritage, with no family history of autoimmune disease. A focused history revealed oral ulceration and an acne-like pustular rash over the back. His gait was antalgic with minimal toe-off phase. Investigations demonstrated raised ESR and CRP, negative autoimmune immunology, negative myositis ENA, normal CK, and positive HLA-B51. Given these features, a provisional diagnosis of Behçet’s was made. Nerve conduction studies were requested to consider whether changes could be secondary to denervation. They displayed non-specific S1 neurogenic changes and small tibial motor amplitudes. Subsequent MRI lumbar spine excluded radiculopathy. Repeat CK remained within normal limits. Muscle biopsy was sought and performed with a clinical suspicion of atypical myositis which has previously been reported in Behçet’s. At the second episode of visual loss, he was admitted under ophthalmology and treated with intravenous methylprednisolone and azathioprine. The case was discussed with our regional centre of excellence for Behçet’s and infliximab at 5mg/kg was commenced. Discussion This case was notable for the complexity and atypical presenting features with calf pain induced by exercise likely due to atypical myositis (biopsy report still awaited at time of submission). More classical Behçet’s disease symptoms including oro-genital ulceration were significantly later. The case highlights the importance of multidisciplinary working and involving specialist centres especially when rapid escalation to biologic treatment is required. Leg symptoms are persistent but improved despite ongoing treatment with prednisolone and azathioprine with the recent addition of infliximab. Visual symptoms have stabilised and skin involvement has settled. Management Rationale At the time of first review in rheumatology clinic, high-dose steroid treatment had already been initiated; therefore, expediting the investigative aspect of his management felt most appropriate, particularly given that myositis seemed to be the predominant feature at that time. In joint consultation with neurophysiology and neurology, putting the EMG and MRI findings in context, MRI of the lumbar spine was felt necessary to exclude discogenic disease causing denervation oedema. Unfortunately, visual symptoms progressed rapidly after this, requiring admission, which precluded an earlier opportunity for biopsy but leading to quick authorisation and organisation of treatment with infliximab. Key learning points This case highlights an atypical presentation of Behçet’s disease including associated likely atypical myositis. Causes of exercise-induced leg pain in a young, fit patient need to be considered: The need for multidisciplinary discussion both across specialties and with regional centres is key in order to progress with diagnostics and treatment In sharing this case for discussion, we wish to highlight possible causes of exercise-induced calf pain and a pathway for investigation of this. Our patient had atypical myositis as the cause for his symptoms in the context of multi-system disease. Both his myositis and ophthalmology presentations were somewhat atypical but multidisciplinary working, along with the development of some further symptoms, were helpful in making the diagnosis.

An alarming rise in COVID-19-related acute macular neuroretinopathy in China: a cross-sectional multimodal imaging study.

COVID-19-related acute macular neuroretinopathy rapidly increased in the pandemic surge in China in December 2022. Possible risk factors and pathophysiological mechanisms including inflammatory responses, vascular factors, and sex hormones have been discussed. Multimodal imaging revealed structural damage and vascular deficits in the retina and choroid, which warrants continuous observation.

Concomitant paracentral acute middle maculopathy and acute macular neuroretinopathy in eyes post-blunt trauma.

To analyze the imaging characteristics and the clinical course of patients showing concomitant paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) post-blunt trauma. PAMM and AMN lesions post-blunt trauma diagnosed on enhanced depth imaging optical coherence tomography (EDI-OCT) were recruited for the study. : Thirteen eyes of 13 individuals with a history of blunt trauma were included in the study, of whom 11 (85%) were males. Mean age of the patients was 33.62 (range 16-67) years. Mean visual acuity at presentation and the last visit was 1.67 log of minimum angle of resolution (logMAR) and 0.82 logMAR, respectively. Mean interval between trauma and imaging was 5.08 (range 1-15) days. All patients had unilateral involvement, with the right eye being involved in 10 patients (77%). All patients had concomitant PAMM and AMN lesions. : Presence of coincident PAMM and AMN suggests a common pathophysiologic etiology, but the description of concomitant PAMM and AMN in the setting of blunt trauma to eye is hitherto unreported. Identifying AMN in a setting of PAMM requires meticulous examination of the OCT and OCTA images. It can be a cause of suboptimal visual recovery in such eyes.

Acute macular neuroretinopathy following Moderna COVID-19 vaccination

PurposeTo describe the occurrence of an acute macular neuroretinopathy (AMN) after administration of a Moderna COVID-19 Vaccine.Methods Case report.ResultsA 23-year-old female presented bilateral visual loss one week after the first dose of COVID-19 vaccine. Fundus examination revealed the classic wedge-shaped lesions with petaloid configuration around both foveas. Hypo-reflective macular lesions are evident in the near-infrared reflectance image. The spectral-domain optical coherence tomography reveled hyperreflectivity of the outer nuclear and plexiform layers, attenuation of the ellipsoid zone and disruption of interdigitation zone corresponding to the lesions.ConclusionsDespite the large number of doses of COVID-19 vaccines administered worldwide, there are not many reported cases of AMN. Most of them occurred after viral vector vaccines. Described here is one of the few cases that observed a time period of several days after receiving the Moderna messenger RNA vaccine. It is not possible to establish causality although this suggests an inflammatory or autoimmune response to the vaccine.

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

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. 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). 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. 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.

Are Women with COVID-19 and Migraine Prone to AMN Type 2?

Purpose: To describe 3 cases of acute macular neuroretinopathy (AMN) type 2 associated with SARS-CoV-2 viral infection and migraine. Methods: Observational case series and literature review. Results: The three patients, which were all women in their reproductive years with a mean age of 31 (range, 22-43), were diagnosed with AMN type 2 after presenting with acute onset of uni- or bilateral persisting paracentral scotomata. On multi-modal imaging with near-infrared (NIR) reflectance imaging, wedge-shaped dark-gray lesions were discernable in a perifoveal petaloid configuration. SD-OCT through the lesions revealed initial hyperreflectivity at the level of the outer retina, beneath the OPL (outer plexiform layer) and comprising the ONL (outer nuclear layer), with disruption of the inner segment/outer segment (IS/OS) band, eventually evolving into thinning of the ONL with or without persisting disruption of the photoreceptor complex. Anterior segment, fundoscopic, angiographic and electrophysiologic examinations were unremarkable. Conclusion: All three cases were diagnosed with a concurrent viral upper respiratory tract infection caused by the SARS-CoV-2 virus. While AMN is considered to be a rare disease, a worldwide surge in the incidence of AMN has recently been reported and the largest case series to date have been described during the latest SARS-CoV-2 viral pandemic. Thus, COVID-19 could be considered a potential risk factor for the development of AMN type 2. Two of our cases were associated with migraine, one of which experienced the onset of AMN symptoms in the immediate setting of a migraine attack and the use of triptans. This association between migraine, triptans and AMN type 2 should be considered in the context of a seemingly persisting visual aura, particularly in the presence of additional risk factors, such as female gender and oral contraceptive use. Summary statement An increased incidence of acute macular neuroretinopathy (AMN) type 2 is observed in the context of SARS-CoV-2 viral infection. The presently described association between AMN, migraine, and triptans should be considered when examining a patient with seemingly persisting visual aura, in particular negative scotomata, in the context of migraine.

Bilateral Acute Macular Neuroretinopathy (AMN) after COVID-19 and its Clinical Course.

Acute macular neuroretinopathy (AMN) is a rare disease entity. It is mainly observed in young women with a history of influenza-like infection or who have been taking oral contraceptives for several years. Patients typically describe subjective visual deterioration and mono- or bilateral paracentral relative scotomas. In some cases, funduscopic ophthalmic examination may reveal subtle sharply demarcated flat lesions of reddish-brown or orange colour in the macular region. Diagnosis is usually made by near-infrared fundus imaging which shows hyporeflective areas, and SD-OCT imaging which manifests changes in the outer retinal layers. In the following, three patient cases with bilateral AMN are described which occurred in direct temporal relationship to a recent SARS-CoV-2 infection.