Multimodal imaging of a Paracentral acute middle maculopathy following COVID-19 infection

Author: Ana Maria Cunha (Portugal)

Co-authors: Ana Maria Cunha, Cláudia Oliveira-Ferreira, Rodrigo Vilares-Morgado, Ângela Carneiro, Fernando Falcão-Reis

Purpose

Our purpose is to describe the features of multimodal imaging in the case of a paracentral acute middle maculopathy following Coronavirus disease 2019 (COVID-19) infection.

Setting/Venue

Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal

Methods

A complete ophthalmologic examination, fundus photography, MultiColor, fundus autofluorescence (FAF), near infra-red imaging (NIR), spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA) and Optical Coherence Tomography Angiography (OCT-A) were performed.

Results

We present the case of a healthy 45-year-old, Caucasian woman with a sudden superior nasal relative scotoma in the left eye. She had been infected with COVID-19 in the 3 weeks prior to onset. Her best-corrected visual acuity was 10/10 for the right eye and 8/10 for the left eye. Fundus examination of whitish edema of the lower hemimacula in the left eye scanned by the SD-OCT showed a hyperreflective band in the inner nuclear and inner plexiform layers, which spared the outer retina. Fluorescein angiography revealed no areas of leakage or vascular exudation in early or late phases. OCT-A showed a decrease in vascular density of the superficial and deep plexus below the fovea. A visual field test was performed, revealing a focal superior paracentral loss of sensitivity. In addition to ophthalmic changes, the patient had paresthesia in the left hand, the left half of the upper and lower lip and tongue, which translated into ischemic stroke of the right parietal cortex in brain MRI.

Conlusions

Covid-19 infection was potentially a trigger for retinal vascular and cortex vascular damage in our patient.

Financial Disclosure

None

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