Journal List > J Korean Ophthalmol Soc > v.54(10) > 1009518

Lee, Bae, and Kim: A Case of Bilateral Acute Macular Neuroretinopathy after URI

Abstract

Purpose

To report a case of bilateral acute macular neuroretinopathy (AMN) following flu-like illness.

Case summary

A 42-year-old woman complained of paracentral scotoma in both eyes 2 weeks after an episode of flu. Fundus examination showed several dark, brown-reddish, wedge- shaped lesions in both maculae, and red-free fundus photography confirmed the lesions. Fluorescein and indocyanine green angiography was normal. Amsler grid test demonstrated paracentral scotoma. The multifocal electroretinogram (ERG) response was subnormal, and ocular coherence tomography (OCT) confirmed an impaired photoreceptor layer in both eyes. Under the diagnosis of AMN, the patient was fol- lowed-up without treatment. No subjective changes were observed during follow-up, although the damage to the photoreceptor was partially recovered based on spectral-domain OCT (SD-OCT).

Conclusions

Multifocal ERG and SD-OCT may be helpful to diagnose AMN. Despite partial recovery of clinical signs on SD-OCT, paracentral scotoma could be sustained for a long period of time.

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Figure 1.
(A, B) Fundus photographs show subtle, patchy reddish brown discoloration. (C, D) Red-free fundus photographs show focal petaloid dark lesion. (E, F) FAG shows normal findings. (G, H) ICGA shows normal findings.
jkos-54-1614f1.tif
Figure 2.
The patient's Amsler grid drawing shows paracentral scotoma corresponding to the abnormalities on fundui photographs.
jkos-54-1614f2.tif
Figure 3.
(A, B) TD-OCT shows defects in the inner margin of the high signal outer band (white arrows). After 6 months, (C, D) TD-OCT shows partial resolution of defect in both eyes. (E, F) After 6 months, SD-OCT shows focal signal reduction in the junction of the photorecepter outer segment with the retinal pigment epithelium (yellow arrow). (G, H) After 2 years, SD-OCT shows slight improvement in both eyes.
jkos-54-1614f3.tif
Figure 4.
(A, B) Trace arrays show reduced response in fovea. (C, D) Topographic maps of multifocal ERG show reduced response in fovea corresponding to the field defects of Amsler grid.
jkos-54-1614f4.tif
Figure 5.
After 6 months, (A, B) Fundus photographs show less discrete reddish brown discoloration. (C, D) Red-free fundus photographs show less clear petaloid dark lesion. After 2 years, (E, F) Red-free fundus photographs show slight improvement.
jkos-54-1614f5.tif
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