Author: Abul Barkat Mustafa Ikhlaq (Spain)
Co-authors: Alejandro Filloy-Rius, Beatriz Torrellas-Darvas, Manuel Castro-Díaz
Purpose
INTRODUCTION Acute macular neuroretinopathy (AMN) is an infrequent macular disease characterized by sudden onset of visual acuity loss and paracentral scotoma in one or both eyes. It presents with intraretinal reddish-brown, wedge-shaped lesions aiming towards the fovea and is thought to be ischemic in origin involving the deep retinal capillary plexus (DCP) thus affecting specially the outer nuclear layer. PURPOSE To present a case of bilateral AMN in a young healthy patient, describe its features in multimodal imaging and analyze the retinal microvasculature alterations demonstrated with Optical coherence tomography angiography (OCTA) as well as to compare it to healthy subjects.
Setting/Venue
The case was conducted at the Joan XXIII University Hospital in Tarragona (Spain) from octuber 2019 to february 2021.
Methods
METHODS Multimodal imaging, including fundus photography autofluorescence (FA), Swept-source OCT and OCTA was performed on the patient and control subjects. Vessel density of superficial capillary plexus (SCP), DCP and choroid, as well as the area of foveal avascular zone (FAZ) were automatically measured. We also assessed the overall vascular structure of SCP and DCP and compared with the same parameters in age-sex-matched healthy controls. CASE REPORT A 26-year-old woman presented with a 6 months’ history of decreased visual acuity and paracentral scotomas in both eyes. The patient described the onset of symptoms to be acute, more marked in her right eye and having remained stable almost since presentation. There was no history of disease or trauma. The clinical interrogation being only remarkable for the use of oral contraceptives. The patient was referred to the retina department after extensive investigation by the neuro-ophthalmology unit.
Results
RESULTS Best-corrected visual acuity was 0.9 in the right eye (RE) and 0.8 in the left eye (LE). Slit lamp examination was unremarkable. Dilated fundus examinations was normal in both eyes except for persistence of myelin fibers in the upper temporal arch of the RE. Swept-Source OCT showed a decrease of retinal thickness temporal to the fovea, located at the nuclear and outer plexiform layers. OCTA showed structural changes in the vessels, especially in DCP with a diffuse decrease in density. The vessel density of the DCP at the FAZ was found to be lower compared to control eyes (11.94% RE; 11.45 % LE vs 15.93- 25.71 % in control eyes). The vessel density of the SCP showed similar changes while being more markedly affected in the RE (5.83 % RE; 11.30 % LE vs 16.77-26.81 % in control eyes). Total area of FAZ was larger in both patient's eyes: 1.012.852 µm2 at SCP and 1.105.049 µm2 at DCP in RE and 645.293 µm2 at SCP and 850.693 at DCP in LE vs control eyes 153,721- 331.260 µm2 at SCP and 131,572-341.279 µm2 at DCP. The visual field test, FA, magnetic-resonance imaging as well as visual-evoked potential testing were unremarkable.
Conlusions
CONCLUSIONS Although rare, AMN can present bilaterally. It must be considered in young patients complaining of central visual acuity loss with seemingly unremarkable exploration. The level of detail of newer OCT technologies is able to discriminate the changes occurring within different retinal layers. In our case, OCTA demonstrated a decrease in the vessel density of both the DCP and SCP while structural OCT showed a thinning of the outer layers.
Financial Disclosure
No financial interest
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