Unilateral Acute Idiopathic Maculopathy Research Articles

Unilateral acute idiopathic maculopathy in hand, foot, and mouth disease

Unilateral acute idiopathic maculopathy in hand, foot, and mouth disease

Unilateral Acute Idiopathic Maculopathy Follow up by Optical Coherence Tomography Angiography a Case Report

Unilateral Acute Idiopathic Maculopathy Follow up by Optical Coherence Tomography Angiography a Case Report

Case Report: Improved Choroidal Circulation in a Patient with Unilateral Acute Idiopathic Maculopathy

Unilateral acute idiopathic maculopathy is a rare retinochoroidal disorder, the cause of which is unknown. Multimodal retinal imaging obtained in this case suggests that the cause of unilateral acute idiopathic maculopathy is impaired choroidal circulation. This study aimed to report a patient with unilateral acute idiopathic maculopathy who showed improvement of choroidal circulation over time in optical coherence tomography angiography images. A 33-year-old woman with a prodromal flu-like illness noticed a sudden central visual field abnormality in the right eye. Five days after the onset, best-corrected visual acuity was 0.15 in the right eye. Fundus photography showed a yellowish lesion at the macula in the right eye. Optical coherence tomography showed a blurred ellipsoid zone and a thickened retinal pigment epithelium at the fovea and a disrupted/blurred ellipsoid zone and retinal pigment epithelium at the parafovea. Optical coherence tomography angiography segmentation of the choriocapillaris revealed a hypointense region at the fovea with a hyperintense region surrounding it. One week after the onset, best-corrected visual acuity was improved from 0.15 to 2.0 in the right eye. Furthermore, the yellowish macula lesion shrank, and the outer retinal layers showed improvement in optical coherence tomography. Optical coherence tomography angiography showed reduction of the hypointense region and enlargement of the hyperintense region. Approximately 1 year after the onset, the yellowish lesion was faded. Optical coherence tomography revealed an almost normal ellipsoid zone but a thickened interdigitation zone. Optical coherence tomography angiography also revealed an apparent hyperintense instead of the hypointense region and increased choroidal blood flow. The current patient showed a gradual recovery of choroidal circulation and outer retinal layer morphology 1 year after the onset of unilateral acute idiopathic maculopathy. Optical coherence tomography angiography findings indicated that the primary cause of unilateral acute idiopathic maculopathy was impaired choroidal circulation, and choroidal vessels improved morphologically over the disease course.

A pediatric case of West Nile virus chorioretinitis associated with unilateral acute idiopathic maculopathy

<br>We report a pediatric case of unilateral acute idiopathic maculopathy (UAIM) associated with West Nile virus (WNV) infection. A 10-year-old child with a 15-day history of presumed acute viral encephalitis, complained of blurred vision in the right eye. Clinical and multimodal imaging findings, including disruption of the foveal ellipsoid zone (EZ) with preservation of the external limiting membrane on Swept Source OCT (SS OCT), were consistent with UAIM. The finding of associated curvilinear chorioretinal lesions in the setting of encephalitis led a diagnosis of WNV infection to be considered and subsequently confirmed by serology. The EZ spontaneously restored over a few weeks with near complete visual recovery. This is a unique pediatric case of UAIM associated with serologically proven WNV infection.<br>

Incidental unilateral idiopathic maculopathy in children

PurposeTo investigate the clinical findings and differential diagnosis of incidental unilateral discoid maculopathy in a case series of children.MethodsThe medical records and retinal imaging of children referred to a single center for flat, well circumscribed, hypopigmented discoid macular lesion in the left eye were reviewed retrospectively.ResultsThree children (age range, 4-11 years; 2 female), with no subjective ophthalmic complaints, were referred for investigation of a flat, well-circumscribed, hypopigmented discoid macular lesion in the left eye. Case 1 had a history of viral mesenteric adenitis, and case 2 had a history of hand, foot, and mouth disease. For case 3, no previous history of systemic viral infection was established. Snellen visual acuity was 20/20 for all 3 children. The lesion was located superior to the fovea for case 1 and centered to the fovea for cases 2 and 3, all in the left eye. In all 3 patients, hyperautofluorescent changes were noted around the edges of the lesion, which was roughly discoid. OCT showed subtle changes of the interdigitation zone and retinal pigment epithelium (RPE) for cases 1 and 2. In case 3 the presence of hyperreflective, hypertrophic tissue at the level of the interdigitation zone and/or the RPE was noted.ConclusionsIn these 3 children with subclinical, unilateral discoid maculopathy sharing common features and identified incidentally, previous viral illness may have been causative. These cases may represent resolved unilateral acute idiopathic maculopathy.

Atypical findings in unilateral Acute Idiopathic Maculopathy: a case report

Acute idiopathic maculopathy (AIM) is a condition reported to occur in young adults, which is classically characterized by the development of a unilateral serous macular detachment that commonly follows a flu-like illness. A 27-year-old female patient complained of diminution of vision in her left eye, of acute onset and progressive course for 2 weeks. She had a history of a flu-like condition 2 weeks prior. Following clinical examination, multimodal imaging analysis, and laboratory investigations, she was diagnosed with unilateral AIM, associated with atypical findings that were not previously reported to occur with AIM, including cystoid macular edema, flame shaped retinal hemorrhages, extensive hard exudates, and juxta-foveal yellowish intraretinal lesions. This may have been due to the more severe inflammation and concomitant phlebitis that was associated with this case compared to previously reported AIM cases.

Presentación multifocal en 2 casos de maculopatía unilateral aguda idiopática

Two cases of multifocal unilateral acute idiopathic maculopathy are presented, one in a 24 year-old man, and another in a 37 year-old woman. Both of them presented with acute vision loss and clinical findings compatible with unilateral acute idiopathic maculopathy. As a relatively uncommon finding, they had multifocal lesions around a larger central lesion. They experienced a spontaneous improvement of their vision.Atypical presentations of unilateral acute idiopathic maculopathy like multifocal lesions are possible. Ophthalmologists should be aware of this rare form of presentation.

Analysis the clinical characteristics of unilateral acute idiopathic maculopathy

Objective To observe the clinical characteristics and fundus imaging features of unilateral acute idiopathic maculopathy (UAIM). Methods Retrospective cases series. Six eyes of 6 patients with UAIM were included in this study. There were 4 males and 2 females. All patients underwent best corrected visual acuity (BCVA), fundus color photography, spectral domain optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA) examinations. 3 patients underwent indocyanine green angiography (ICGA) examination. No intervention was given in all patients after diagnosis. The mean follow-up was 6.3 months. BCVA, fundus color photography, SD-OCT and FFA were performed in follow-up. Results The ocular symptoms included unilateral sudden decreased vision, metamorphopsia and central scotoma. All patients had a yellow-white lesion involving the macular and irregular small bleeding was seen in 3 eyes. Irregular hyper-fluorescence in macular area was seen in all patients, some with the hemorrhages showed blocked fluorescence at the early stage of FFA and fluorescence storage at the late stage. ICGA showed that hypo-fluorescence in macular area continually. SD-OCT showed that subretinal fluid in the macular and lost the ellipsoid zone. During the follow-up period, the subretinal fluid was absorbed spontaneously in one month. The ellipsoid zone structure recovered gradually and the visual acuity were normal. At the time of the latest follow-up, the BCVA was 0.8 in 4 eyes, 1.0 in 2 eyes. Conclusions UAIM is featured with a unilateral, acute, transient and exudative lesion in the macular, which can be spontaneously resolved; It mainly affects outer retina. Key words: Macula lutea/injuries; Retinal Diseases/diagnosis; Disease attributes

Bilateral idiopathic retinal vasculitis following coxsackievirus A4 infection: a case report

BackgroundCoxsackieviruses are members of a group of viruses called the enteroviruses, which may cause respiratory and gastrointestinal symptoms, erythema, meningoencephalitis, myocarditis, pericarditis, and myositis. Unilateral acute idiopathic maculopathy caused by coxsackievirus A16 has been associated with hand, foot, and mouth disease, but only a few reports describe retinitis associated with coxsackievirus serotype B3 or B4. We report a case of bilateral multifocal obstructive retinal vasculitis that developed after coxsackievirus A4 infection.Case presentationA 60-year-old woman was referred to our department with bilateral visual disturbance that developed following flu-like symptoms. At the initial examination, best corrected visual acuity was 20/200 in the right eye and 20/50 in the left eye. The critical flicker frequency (CFF) was 23 Hz in the right eye and 27 Hz in the left eye. Fine white keratic precipitates with infiltrating cells were presented in the anterior chamber of both eyes, and multifocal retinal ischemic lesions were observed in the macula and posterior pole of both eyes. The retinal lesions corresponded with scotomas observed in Goldmann visual field test. On spectral domain-optical coherence tomography (SD-OCT), retinal lesions were depicted as hyper-reflective regions in the inner retina layers in both eyes, and disruption of ellipsoid line in the left eye., Fluorescein angiography exhibited findings indicative of multifocal obstructive retinal vasculitis. The patient had a history of current hypertension treated with oral therapy and glaucoma treated with latanoprost eye drops. Blood test for coxsackievirus antibody titers revealed that A4, A6, A9, B1, B2, B3, and B5 were positive (titers: 8–32). Abdominal skin biopsy of necrotic tissue suggested vascular damage caused by coxsackievirus. The general symptoms improved after 6 weeks, and the multifocal retinal ischemic lesions were partially resolved with residual slightly hard exudates. Only coxsackievirus A4 antibody titer increased from 4 to 32-fold after 14 months. However, hyper-reflective regions and disruption of the inner retinal layers on SD-OCT persisted especially in the right eye, and residual paracentral scotoma was observed in the right eye.ConclusionThe present case suggests that coxsackievirus A4 causes bilateral multifocal obstructive retinal vasculitis with irreversible inner retinal damage.

Increased choroidal blood flow velocity with regression of unilateral acute idiopathic maculopathy.

The pathogenesis of unilateral acute idiopathic maculopathy (UAIM) is unknown. The aim of this study was to quantitatively examine changes in choroidal circulation hemodynamics in patients with UAIM. This was a retrospective observational case-series which included five eyes of four patients with UAIM. All UAIM eyes and the fellow eyes in remaining three patients were studied using laser speckle flowgraphy (LSFG) to evaluate the mean blur rate (MBR), a quantitative index of relative blood flow velocity. The changes in MBR between the initial visit and after 1 and 3 months were statistically analyzed. Subfoveal choroidal thickness was measured in three UAIM eyes by enhanced depth imaging optical coherence tomography. The mean logMAR value of best-corrected visual acuity in the UAIM eyes significantly improved (P = 0.04) with recovery of outer retinal morphology. The average MBR of the UAIM eyes significantly increased at 1 (+21.7% baseline value; P = 0.003) and 3 months (+32.5% baseline value; P = 0.001), whereas the fellow eyes did not show this tendency. The mean values of subfoveal choroidal thickness decreased with time (316.0 µm at baseline, 186.6 µm at 1 month, and 167.3 µm at 3 months). These results reveal that there is a significant elevation of choroidal blood flow velocity and substantial reduction of choroidal thickness with regression of UAIM, suggesting that impaired choroidal circulation may be involved in the pathogenesis of UAIM.

Multimodality Diagnostic Imaging in Unilateral Acute Idiopathic Maculopathy

Purpose: To report multimodality diagnostic imaging in a case of unilateral acute idiopathic maculopathy. Case summary: A 32-year-old woman with reduced vision in the right eye had experienced fatigue and flu-like symptoms, including sore throat and fever a few days before. Her best corrected visual acuity (BCVA) was 1.0 in the right eye. There were no cells in the anterior chamber and vitreous. Fundus photographs of the right eye on presentation showed gray-white thickening of the fovea and retinal hemorrhage next to the fovea. Fluorescein angiography demonstrated ring-shaped mottled hyperfluorescence in the early phase and dye pooling in the late phase. Spectral-domain optical coherence tomography (OCT) showed abnormal hyper-reflective thickening at the level of the outer retina and retinal pigment epithelium (RPE) and detachment of the neurosensory retina in the foveal lesion. The inner segment/outer segment junction and photoreceptor elevation/disruption was noted. Nineteen months after onset, the BCVA of the right eye was 1.0 and fundus photographs showed increased retinal pigment hyperplasia, and residual RPE changes resembling a bull’s eye maculopathy. The OCT of the right macula showed that the inner segment/outer segment junction elevation/disruption almost completely regressed. The patient was diagnosed with unilateral acute idiopathic maculopathy. Conclusions: We report a typical case with flu-like symptoms of unilateral acute idiopathic maculopathy. It is a very rare macular disease and a case such as ours with long-term follow-up using multimodality diagnostic imaging has not been previously reported. J Korean Ophthalmol Soc 2015;56(1):142-147

Fundus autofluorescence features in the inflammatory maculopathies.

PurposeTo describe the fundus autofluorescence (FAF) features of the inflammatory maculopathies and develop a quantification method for FAF analysis.MethodsThis is a retrospective, consecutive case series of patients with inflammatory maculopathies from two tertiary centers. The clinical findings, demographics, and FAF imaging characteristics were reviewed. Foveal autofluorescence (AF) was analyzed. Median and standard deviation (SD) of foveal AF intensity were measured.ResultsThirty eyes of 15 patients were evaluated with both qualitative and quantitative FAF analysis. In acute macular neuroretinopathy, the active phase showed foveal hypoautofluorescence, which became hypoautofluorescent with resolution. In acute posterior multifocal placoid pigment epitheliopathy, multiple lesions with hypoautofluorescent centers with hyperautofluorescent borders were observed in active disease and became hypoautofluorescent with disease convalescence. In multifocal choroiditis and punctate inner choroiditis, the active hyperautofluorescent lesions progressed to inactive, hypoautofluorescent scars. Active serpiginous choroiditis showed hyperautofluorescent borders adjacent to a helicoid-shaped, hypoautofluorescent scar. Active unilateral acute idiopathic maculopathy (UAIM) showed a complex pattern of hypo- and hyperautoflourescence in the macula. The median foveal AF was the greatest in acute macular neuroretinopathy and UAIM among the maculopathies, while the greatest SD of foveal AF intensity was observed in UAIM.ConclusionThe active phase of the majority of inflammatory maculopathies was characterized by hyperautofluorescent lesions. Increased SD of foveal AF correlated with a mixture of hypo-and hyperautoflourescence. Median and SD may be useful metrics in foveal AF and quantifiable values that may be assessed over time as a disease process evolves. Improvements in quantification methods of FAF imaging may allow us to objectively evaluate posterior uveitis.

Multimodal Imaging of Exudative Maculopathy Associated With Hand-Foot-Mouth Disease

A 31-year-old man presented with acute unilateral visual loss secondary to hand-foot-mouth disease (HFMD). Ophthalmic examination demonstrated best corrected visual acuity (BCVA) of 6/24 and a macular neurosensory detachment. He was diagnosed with unilateral acute idiopathic maculopathy (UAIM), and multimodality imaging was performed. No treatment was warranted. At 3 months, BCVA was 6/5 and funduscopy revealed a juxtafoveal scar. Based on the evidence of the association between HFMD and UAIM, the authors refer to this condition as exudative maculopathy associated with HFMD. Multimodality imaging during acute and convalescent phases is useful to study this disorder and raises questions about choroidal and bilateral involvement. Ophthalmologists should be aware of this and query about systemic signs and symptoms.

Early Spectral-Domain Optical Coherence Tomography Findings in Unilateral Acute Idiopathic Maculopathy

Early Spectral-Domain Optical Coherence Tomography Findings in Unilateral Acute Idiopathic Maculopathy

Unilateral Acute Idiopathic Maculopathy in a 14-year-old Hispanic Girl

The authors discuss a case of unilateral diminished vision in a 14-year-old Hispanic girl. Retrospective chart review. The patient was referred to University Hospital (UH) at New Jersey Medical School with a complaint of blurry vision in the right eye for approximately 1 month. Clinical examination showed a yellow-gray area of retinal pigment epithelium (RPE) elevation in the perifoveal region OD and normal examination OS. Optical coherence tomography showed a corresponding area of RPE elevation with associated sub-RPE fluid. Fluorescein angiogram on presentation disclosed a focal area of hyperfluorescence and dye pooling. Bloodwork and chest x-ray were within normal limits. These changes resolved over the ensuing 4 weeks despite discontinuation of all treatment. The patient experienced complete resolution of her symptoms. We report a case of unilateral acute idiopathic maculopathy in a 14-year-old Hispanic girl. To the authors' knowledge, this is the youngest reported patient with this condition to date.

Unilateral Acute Maculopathy Related to Hand, Foot, and Mouth Disease: OCT and Fluorescein Angiography Findings of a Very Rare Disease

Hand, foot, and mouth disease is a contagious enteroviral infection occurring primarily in children and characterized by vesicular palmoplantar eruptions and erosive stomatitis. There are very few cases of unilateral acute idiopathic maculopathy associated with hand, foot, and mouth infection. We described a case with unilateral outer retinitis occurring a few days after the onset of disease. A 30-year-old man with reduced vision in his right eye underwent complete ophthalmologic examination including fluorescein angiography and spectral optical coherence tomography. Fundus fluorescein angiography demonstrated mottled hyperfluorescence in the early phase and leakage in the late phase. Spectral domain optical coherence tomography revealed subretinal fluid suggesting a serous detachment and also showed mild intraretinal cystic changes. The fluid disappeared in 1 week with some retinal pigment epithelium changes in the center of the macula. Although this disease is a viral infection associated with reversible symptoms, this case suggests that it can resolve with mild visual loss, and the disease should be considered in the differential diagnosis of acute central serous chorioretinopathy.

Atypical findings in delayed presentation of unilateral acute idiopathic maculopathy

Unilateral acute idiopathic maculopathy is a rare disease affecting young healthy patients resulting in moderate to severe unilateral visual loss preceded by prodromal flu-like illness. We present a case of delayed presentation of unilateral acute idiopathic maculopathy associated with hand, foot and mouth disease.

Unilateral Acute Idiopathic Maculopathy Associated with Hand-Foot-Mouth Disease

Unilateral acute idiopathic maculopathy (UAIM) is a rare disorder that has been linked with coxsackie virus. It was initially described by Yannuzzi et al. [1] in a series of 9 patients in 1991. A viral prodrome is common. We aim to add to the literature a case of challenging visual symptoms associated with resolved hand-footmouth disease, suggesting presumed UAIM.

Unilateral Acute Idiopathic Maculopathy

This is a report of nine patients who experienced sudden, severe, unilateral central vision loss following a flulike illness. Each patient had an exudative detachment of the macula. All patients experienced a spontaneous resolution of the acute macular manifestations with near-complete recovery of vision. A characteristic "bull's-eye" appearance in the macula persisted. The acute manifestations of the disorder did not recur in any of the patients during the period of follow-up. The constellation of findings was suggestive of an inflammatory disease of the retinal pigment epithelium, but a specific causative agent could not be identified. The acute clinical and angiographic features, the natural course, and the residual pigment epithelial derangement were not consistent with any previously described disorder.

Resolution of photoreceptor outer segment damage in a patient with unilateral acute idiopathic maculopathy observed using spectral-domain optical coherence tomography

Resolution of photoreceptor outer segment damage in a patient with unilateral acute idiopathic maculopathy observed using spectral-domain optical coherence tomography