Author: Joana Fernandes (Portugal)
Co-authors: Filipe Neves, Ricardo Machado Soares, Catarina Cunha Ferreira, Eduardo Saraiva, Lígia Ribeiro
Purpose
The ongoing pandemic of COVID-19 disease has been associated with variable ocular manifestations. An inflammatory and pro-coagulant state has been associated to COVID-19 disease, however its effect over the retinal vascular system has not been completely elucidated. There are some cases of retinal venous occlusion and retinal artery occlusion described in this context. This case report aims to describe an atypical case of acute macular neuroretinopathy (AMN) following SARS-CoV-2 infection.
Setting/Venue
Department of Ophthalmology of Centro Hospitalar Vila Nova de Gaia/Espinho.
Methods
Case report of a patient seen in the emergency department, with sudden onset of central scotomas and recent SARS-CoV-2 infection, who underwent a complete ophthalmological evaluation, which included multimodal evaluation of the posterior pole with retinography, spectral domain optical coherence tomography, angiography fluorescein, visual field and electrophysiological study.
Results
A 66-year-old woman presented to the emergency department with complaints of vision loss and sudden onset of central scotomas in her left eye (LE) for the past 24 hours. Her BCVA was “counting fingers” in the LE. Fundus examination of the LE revealed hypopigmented lesions involving the superior macula. SD-OCT imaging of the LE demonstrated hyperreflective band lesions at the level of the INL and OPL corresponding to the hypopigmented lesions observed. The ORL and RPE appeared completely normal. The patient had an innocent medical history with the exception of having a recent history of SARS-CoV2 infection one month ago. The diagnosis of AMN was suspected and the patient was followed without treatment. A larger study of potential causes was conducted, without abnormalities. The patient reported a progressive improvement in visual acuity about 48 hours after the acute episode. At one-month follow up, she stated a complete recovery of visual acuity and absence of scotomas. Her BCVA was 10/10 bilaterally and fundus examination demonstrated regression of the hypopigmented lesions. At this time, the SD-OCT showed INL thinning in areas where the hyper-reflective bands were previously seen. No recurrence was detected in subsequent follow-up examinations.
Conlusions
Thought the mechanism of AMN has been reported to be primarily due to ischemia of the capillary plexus, there is still much to be understood. The suspect of AMN raises a wide differential diagnosis that requires a systemic and pertinent workup to exclude potential infectious, inflammatory, vascular, toxic, and iatrogenic causes. A history of recent viral infection has also been associated with AMN. In this case report, we present a possible association between a SARS- CoV2 infection and AMN in a woman without any risk factors. Further studies should be achieved to better understand this association.
Financial Disclosure
none
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