A Case of Bilateral Acute Macular Neuroretinopathy after URI

Seung Hee Lee; Jin Sung Bae; Yoon Young Kim

doi:10.3341/jkos.2013.54.10.1614

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

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

Original Article

J Korean Ophthalmol Soc 2013;54(10):1614-1620.

Published online: 3 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.10.1614

A Case of Bilateral Acute Macular Neuroretinopathy after URI

Seung Hee Lee, MD, Jin Sung Bae, MD, Yoon Young Kim, MD, PhD

Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea

Address reprint requests to Yoon Young Kim, MD, PhD, Department of Ophthalmology, Daegu Catholic University Medical Center, #33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea, Tel: 82-53-650-4728, Fax: 82-53-627-0133, E-mail: yykim@cu.ac.kr

Received 8 March 2013 Revised 30 May 2013 Accepted 24 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Acute macular neuroretinopathy, Multifocal electroretinography, Spectral-domain optical coherence tomography

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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.

Figure 2.

The patient's Amsler grid drawing shows paracentral scotoma corresponding to the abnormalities on fundui photographs.

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.

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.

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.

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