A Case of Acute Macular Neuroretinopathy after Non-ocular Trauma

Se Eun Kim; Si Eun Lee; Yun-young Kim

doi:10.3341/jkos.2016.57.12.1970

Journal List > J Korean Ophthalmol Soc > v.57(12) > 1010490

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Kim, Lee, and Kim: A Case of Acute Macular Neuroretinopathy after Non-ocular Trauma

Case Report

J Korean Ophthalmol Soc 2016;57(12):1970-1975.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1970

A Case of Acute Macular Neuroretinopathy after Non-ocular Trauma

Se Eun Kim, MD, Si Eun Lee, MD, Yun-young Kim, MD, PhD

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

Address reprint requests to Yun-young Kim, MD, PhD Department of Ophthalmology, Daegu Catholic University Medical Center, #33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: 82-53-650-4728, Fax: 82-53-627-0133 E-mail: yykim@cu.ac.kr

Received 18 August 2016 Revised 20 September 2016 Accepted 10 November 2016

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

In the present study, an unusual case of traumatic retinopathy presenting as acute macular neuroretinopathy was reported.

Case summary

A 69-year-old male was involved in a car accident and experienced a left 5th rib fracture. There was no direct ocular trauma. However, after the accident he noticed paracentral scotoma and loss of vision in his left eye. At initial examination 4 days after the trauma, central visual acuity was hand motion and visual field test revealed central scotoma in the left eye. Spectral domain optical coherence tomography showed hyper-reflectivity of the outer nuclear layer and disruption of the ellipsoid zone. Fluorescein angiography did not show any leakage or vascular damage but near-infrared autofluorescence imaging showed a dark lesion in the macular area. Visual acuity was improved to 0.2 at 2 weeks after trauma and 0.6 at 6 months after trauma while mild ellipsoid zone defect and visual field defect persisted.

Conclusions

Traumatic retinopathy presenting as acute macular neuroretinopathy is an uncommon disease causing paracentral scotomas after non-ocular trauma, and to the best of our knowledge, this is the first reported case in Korea.

Keywords: Acute macular neuroretinopathy, Central scotoma, Traumatic retinopathy

References

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Figure 1.

Images of the left eye four days after car accident. Color fundus photography shows wedge-shaped brown discoloration (arrow) (A). The lesion (arrow) shows more clearly on red-free fundus photography (B). Spectral domain optical coherence tomography revealed hyper-reflectivity of the outer plexiform layer and outer nuclear layer and disruption of ellipsoid zone and interdigitation zone (arrows) (C).

Figure 2.

Near-infrared autofluorescence image of the patient. Near-infrared imaging presents multiple hyporeflective darker lesions in left eye (A). The hyporeflective lesions (green lines) correlate to hyper-reflectivity in the outer nuclear layer and outer plexiform layer on spectral domain optical coherence tomography (B). A B

Figure 3.

Humphrey visual field images of the patient. A Humphrey visual field study confirms paracentral scotoma in the left eye (A). There is no definite visual field defect 2 months after trauma (B).

Figure 4.

Spectral domain optical coherence tomography images of the left eye 2 days and 6 months after trauma. The images display gradual improvement of the hyper-reflectivity within the outer plexiform layer and outer nuclear layer (ONL). But there are thinning of ONL and disruption of ellipsoid zone and interdigitation zone (between arrows).

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