Case Of Acute Macular Neuroretinopathy Research Articles

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 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.

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.

A Case of Acute Macular Neuroretinopathy and its Association with COVID-19

In diesem Bericht wird der Fall einer Frau mit akuter makulärer Neuroretinopathie (AMNR) beschrieben; AMNR ist ein seltenes Krankheitsbild, das durch einen Gefäßverschluss verursacht wird. Es wird auch eine mögliche Assoziation zwischen AMNR und einer COVID-19-Infektion oder COVID-19-Impfung untersucht.

Acute macular neuroretinopathy as the first stage of SARS-CoV-2 infection.

IntroductionTo report two cases of Acute Macular Neuroretinopathy (AMN) presented as the first stage of SARS-CoV-2 infection in two European countries during the third wave of pandemic viral infection in the early months of 2021.ObservationsA unilateral case of type 1 AMN in a man and a bilateral case of type 2 AMN in an otherwise heathy patients were reported. Sudden onset of paracentral scotoma characterized the cases with no systemic symptoms. Structural optical coherence tomography (OCT) shows multifocal middle and inner retinal hyperreflective infarctions. OCT-Angiography showed the presence of hypoperfusion of the deep capillary plexus (DCP) corresponding to the hyperreflective lesions visible on structural OCT, confirming the diagnosis.Conclusions and importanceType 1 and type 2 AMN may be the first stage of SARS-CoV-2 infection. We suggest testing all patients with AMN for SARS-CoV-2. In our cases, the natural history of AMN associated with SARS-CoV-2 infection was similar to already described cases of AMN.

Branch Retinal Artery Occlusions, Paracentral Acute Middle Maculopathy and Acute Macular Neuroretinopathy After COVID-19 Vaccinations.

PurposePotential retinal adverse events after COVID-19 vaccinations reported previously include paracentral acute middle maculopathy (PAMM), acute macular neuroretinopathy (AMN), and central serous chorioretinopathy. We report four cases of branch retinal artery occlusion (BRAO), one case of PAMM, and one case of AMN that occurred after administration of the Pfizer-BioNTech COVID-19 vaccine.Patients and MethodsWe retrospectively reviewed the medical records of six patients who presented to Yame General Hospital or Oita University Hospital from July through October 2021.ResultsFour patients (2 males) presented with visual field defects associated with BRAO, one male patient with PAMM, and one female patient with AMN after receiving the Pfizer-BioNTech COVID-19 vaccine. The mean age was 59.3 years; the mean best-corrected visual acuity was 20/21. The mean time from the last vaccination to the onset of visual field defect was 22.8 days. Five patients had received two doses of the vaccine and one patient one dose. Patients’ medical history included diabetes mellitus in case 2, hypertension in cases 2, 3 and 6, and Alport syndrome and end-stage renal disease in case 6 for which the patient was undergoing regular hemodialysis.ConclusionAlthough rare, retinal adverse events may occur after COVID-19 vaccinations. Further studies with a larger sample size should determine whether these retinal abnormalities are causally associated with COVID-19 vaccinations or just coincidental. Potential risks of BRAO/PAMM/AMN after COVID-19 vaccinations must be carefully weighed against the substantial benefit of COVID-19 vaccinations.

Acute Macular Neuroretinopathy: An Atypical Hemorrhagic Presentation

Acute macular neuroretinopathy (AMN) is a rare disease. We report a clinical case of AMN diagnosed in a 46-year-old, Caucasian female with an atypical exuberant hemorrhagic presenta- tion. She referred unilateral paracentral scotomas started 1 day before admission. Fundoscopy revealed several large, dot-and-blot and flame-shaped intraretinal hemorrhages surrounded by reddish-brown, wedge-shaped lesions pointed towards the fovea. Infrared imaging displayed petalloid dark lesions. Optical coherence tomography showed focal ellipsoid zone disruptions, areas of outer retinal hyperreflectivity and deep intraretinal hemorrhages. Fundus autofluorescence and fluorescein angiography displayed hypofluorescent areas due to intraretinal hemorrhages. One-month after presentation, the patient complained about residual scotomas. Classic reddish-brown, wedge-shaped lesions became well-demarcated and intraretinal hemorrhages almost completely resolved. Tomographic findings partially reversed but converted into outer nuclear layer thinning. Visual field examination displayed paracentral scotomas. Our patient revealed the classic AMN lesions. From our knowledge, this is the first reported AMN case with an extensive hemorrhagic presentation.

Acute macular neuroretinopathy associated with influenza vaccination with decreased flow at the deep capillary plexus on OCT angiography

PurposeWe report a case of acute macular neuroretinopathy (AMN) following routine annual inactivated influenza vaccination. Projection-resolved optical coherence tomography angiography (PR-OCTA) was used to analyze the retinal capillary flow within the AMN lesion. ObservationsOur patient reported visual symptoms of her right eye nine days after routine annual influenza vaccination. Multimodal imaging revealed small vessel peripheral vasculitis and AMN in the affected eye. Infectious, immunologic, and hypercoagulable etiologies were investigated and excluded. PR-OCTA B-scans within the AMN lesion demonstrated reduced flow in the deep capillary plexus (DCP) at baseline with relatively improved flow signal in the DCP on follow up, 3 weeks later. Conclusions and importanceWe report a new association of AMN following routine inactivated influenza immunization. Recent influenza vaccination should be included in the differential diagnosis for patients presenting with AMN. PR-OCTA demonstrated compromised DCP flow in the AMN lesion which has not been previously described.

A Case of Acute Macular Neuroretinopathy in a Young Male

A Case of Acute Macular Neuroretinopathy in a Young Male

A Case of Acute Macular Neuroretinopathy after Non-ocular Trauma

A Case of Acute Macular Neuroretinopathy after Non-ocular Trauma

Acute macular neuroretinopathy associated with systemic lupus erythematosus

Acute macular neuroretinopathy (AMN) is a rare disorder that presents with abrupt visual change with wedge-shaped or flower-like lesions pointing towards the fovea. Ischemic insults to the retinal capillary plexus may be important for development of this disease. While many case reports have been published on AMN, none have described AMN in association with systemic lupus erythematosus (SLE). Here, we report a case of AMN associated with newly-diagnosed SLE. We speculate that in patients with lupus flares, immune complex-mediated vascular injury and microvascular thrombosis may disrupt the deep retinal capillary network, causing ischemic damages to the outer retina and leading to the development of AMN. AMN can develop in patients with lupus flares, and must be considered as an SLE-associated ophthalmologic complication. To the best of our knowledge, this is the first case report of AMN associated with SLE.

This issue of Acta, printed and electronic

This issue of Acta, printed and electronic

Teenage Acute Macular Neuroretinopathy

To present the first case of acute macular neuroretinopathy in a teenager. Case report, optical coherence tomography, fluorescein angiography, electroretinography. Optical coherence tomography, fluorescein angiography, and electroretinography were used to diagnose acute macular neuroretinopathy. Laboratory results were positive for HLA-B7. The rare diagnosis of acute macular neuroretinopathy should be considered in girls on oral contraceptives, with a recent history of acute viral illness, who present with acute rapid onset of multiple, paracentral scotomas.

Atypical presentation of acute macular neuroretinopathy with tiny parafoveal reddish-brown lesions

To report two cases of acute macular neuroretinopathy with unusually small parafoveal lesions, which showed later recurrent lesions either in the same eye or the fellow eye. Observational case series. In case 1, a 48-year-old woman developed a sudden onset of a tiny paracentral scotoma associated with a small reddish-brown paracentral lesion. A new paracentral lesion with a corresponding scotoma developed 1 year later. In case 2, a 39-year-old man with diabetes type 1 developed a paracentral scotoma OS with a corresponding small reddish-brown lesion. Two months later, a similar lesion with a corresponding scotoma developed in the fellow eye. Acute macular neuroretinopathy may present with tiny paracentral lesions difficult to detect with fundus examination, and may be associated with recurrent lesions either in the same eye or the fellow eye.

OUTER RETINAL ABNORMALITIES IN ACUTE MACULAR NEURORETINOPATHY

To investigate the spectral-domain optical coherence tomography findings in four cases of acute macular neuroretinopathy and identify features that may differentiate acute macular neuroretinopathy from similar conditions in the acute zonal occult outer retinopathy complex. Patients with acute macular neuroretinopathy underwent complete periodic examinations, including ophthalmoscopy, color photography and autofluorescence photography, visual field testing, and spectral-domain optical coherence tomography. Abnormalities as seen by multimodal imaging were documented and evaluated during follow-up. The average age of the 4 patients was 32 years (range, 28-34 years), and 2 had bilateral involvement. The follow-up ranged from 1 month to 5 months. In each patient, dark lobular areas seen by ophthalmoscopy corresponded to the measured visual field defect and what appeared to be a regional loss of outer segments of the photoreceptors. The outer segment defect resolved in two patients and improved in the other two during follow-up. All patients showed a colocalizing regional thinning of the outer nuclear layer, which did not change during the follow-up period. There were no associated abnormalities in the fundus appearance. Acute macular neuroretinopathy causes reddish brown patches that are because of outer retinal damage as documented by spectral-domain optical coherence tomography. Unlike other entities in the acute zonal occult outer retinopathy complex, acute macular neuroretinopathy has no other synchronic ophthalmoscopically visible fundus abnormalities. These lesions may resolve over time, with restoration of the outermost retinal architecture, but persistent thinning of the overlying outer nuclear layer remained.

Visualization and follow-up of acute macular neuroretinopathy with the Spectralis® HRA+OCT device

Acute macular neuroretinopathy (AMNR) is a rare disease entity, the diagnosis of which is frequently complicated by the subtlety of biomicroscopic findings. Two cases of AMNR are presented, in which the diagnosis and follow-up was enabled using the Spectralis HRA+OCT in the absence of clear biomicroscopic findings. The typical lesions were visualized by hyporeflexion during infrared imaging and faded over time. With spectral domain optical coherence tomography, changes in the outer retina in the affected regions were documented, with no change over time. The broader availability of this technology may enhance the diagnosis and follow-up of AMNR.