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Mahendradas P, Acharya I, Rana V, Bansal R, Ben Amor H, Khairallah M. Optical Coherence Tomography and Optical Coherence Tomography Angiography in Neglected Diseases. Ocul Immunol Inflamm 2024; 32:1427-1434. [PMID: 37205786 DOI: 10.1080/09273948.2023.2211161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
A group of self-limiting and frequently neglected diseases exist in the literature like Rickettsial disease, Malaria, Dengue fever, Chikungunya, West Nile virus infection, Rift Valley fever, Bartonellosis, or Lyme disease which are poorly understood due to lack of proper diagnostic testing. Currently, multimodal imaging has become a critical modality in the diagnosis and management of ocular diseases. Optical coherence tomography (OCT) is one such remarkable imaging modality in the field of ophthalmology providing high-resolution, cross-sectional images of the retina and choroid with the recent advances such as enhanced depth imaging and swept source OCT. Additionally, OCT angiography (OCTA) has further revolutionised dynamic imaging of retinal and choroidal vasculature non-invasively. This review article highlights the OCT and OCTA biomarkers in the diagnosis and prognosis of the aforementioned neglected diseases.
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Affiliation(s)
| | - Isha Acharya
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, India
| | - Vipin Rana
- Department of Vitreo-Retina, Advanced Eye Centre, PGIMER, Chandigarh, India
| | - Reema Bansal
- Department of Vitreo-Retina, Advanced Eye Centre, PGIMER, Chandigarh, India
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Huang Y, Sun Z, Li Y, Huang S, Zhou R, Yang C, Lin B. Optical coherence tomography characteristics and prognostic predictors of acute macular neuroretinopathy following SARS-CoV-2 infection. Indian J Ophthalmol 2024; 72:1175-1180. [PMID: 39078962 PMCID: PMC11451787 DOI: 10.4103/ijo.ijo_2997_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 10/06/2024] Open
Abstract
PURPOSE To analyze the characteristics of optical coherence tomography in acute macular neuroretinopathy (AMN) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and discuss the prognostic predictors. METHODS Patients with AMN following SARS-CoV-2 infection were divided into two groups according to the presence or absence of hyperreflective outer nuclear layer (ONL) lesion involving the fovea. RESULTS The first visit included 14 eyes in the fovea-involved group and 20 eyes in the no fovea-involved group. Ellipsoid zone (EZ) hyporeflection and interdigitation zone (IZ) interruption were detected in all eyes. Other common manifestations were myoid zone (MZ) hyperreflection (76.5%), ONL hyperreflection (73.5%), outer plexiform layer (OPL) thickening (64.7%), and EZ interruption (50%). The follow-up period was 48.4 ± 55.3 days. At the last visit, 12 eyes were in the fovea-involved group and 13 eyes in the no fovea-involved group. IZ interruption was detected in all eyes. Other common manifestations were EZ hyporeflection (92.0%), ONL atrophy (40.0%), OPL thickening (36.0%), OPL linear (32.0%), and MZ hyperreflection (32%). The improvement of visual acuity (VA) was -0.5 ± 0.5 and -0.2 ± 0.4 in the fovea-involved group and the no fovea-involved group, respectively, with a statistically significant difference between them (P = 0.045). Initial VA, initial cotton wool spot, initial ONL cyst, final ONL cyst, and final OPL linear were associated with final VA (P = 0.000, P = 0.029, P = 0.044, P = 0.049, P = 0.049, respectively). CONCLUSIONS In the early stage of AMN following SARS-CoV-2 infection, IZ interruption and EZ hyporeflection were the most common manifestations, and pathology of IZ was more serious than that of EZ. Subsequently, OPL and ONL atrophied, and ONL atrophied faster. Regardless of whether hyperreflective ONL involved the fovea, VA improved, with a more noticeable improvement found in the fovea-involved group. The presence of initial ONL cyst and initial cotton wool spot, rapid atrophy of OPL, and poorer initial VA indicating poorer VA outcome.
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Affiliation(s)
- Ying Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zuhua Sun
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yingzi Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shenghai Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rong Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chun Yang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bing Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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von der Burchard C, Gruben A, Roider J. Optical coherence tomography angiography suggests choriocapillaris perfusion deficit as etiology of acute macular neuroretinopathy. Graefes Arch Clin Exp Ophthalmol 2024; 262:2471-2479. [PMID: 38512510 PMCID: PMC11271325 DOI: 10.1007/s00417-024-06436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Acute macular neuroretinopathy (AMN) can cause sudden-onset and permanent scotoma in healthy young patients. Analysis of optical coherence tomography (OCT) and OCT angiography (OCTA) of AMN patients may provide insights into disease mechanism. METHODS We conducted a retrospective study of consecutive SARS-Cov-2-related AMN patients that presented in our clinic between Jan 1st, 2022, and April 30th, 2023, within 30 days of symptom onset. Retinal vessel area density (VAD) of AMN lesions in OCTA was quantified and compared to an adjacent tissue control (ATC). This quantification was performed for the superficial vascular plexus (SVP), the intermediate capillary plexus (ICP), the deep capillary plexus (DCP), the choriocapillaris (CC), and choroid. Furthermore, en face OCT images were analyzed. RESULTS Nine AMN patients were identified, 6 of these (4 female, 2 male, average age 25 years) fulfilled the inclusion criteria and were included into this study. Average time from symptom onset to OCTA was 14.3 days. No VAD differences between AMN and adjacent tissue were found in either retinal layer (SVP, ICP, DCP). In contrast, VAD in CC was reduced by 27% against the ATC (p = 0.007) and choroidal VAD was reduced by 41% (p = 0.017). Further analysis of en face OCT could show that the pathognomonic infrared hyporeflectivity in AMN is caused by photoreceptor alterations rather than changes in the inner retinal layers. CONCLUSIONS Our data suggests that a perfusion deficit in the choroidal layers is responsible for AMN rather than in the DCP, which is the predominant hypothesis in current literature.
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Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Arved Gruben
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Agarwal S, Nayak MA, Luthra S, Parakh S. Acute macular neuroretinopathy following Valsalva manoeuvre: an insight into the pathophysiology. BMJ Case Rep 2024; 17:e256685. [PMID: 38724217 PMCID: PMC11085796 DOI: 10.1136/bcr-2023-256685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Acute macular neuroretinopathy (AMN) affects the outer retina and is most likely induced by non-inflammatory ischaemia of the retinal deep capillary plexus and choriocapillaris. A man in his early 20s developed Valsalva retinopathy following weightlifting at the gym and presented with blurring of vision in the left eye 1 month after the initial retinal haemorrhages had resolved. A diffuse, purplish, donut-shaped, perifoveal lesion was seen on funduscopy and was well defined by an optical coherence tomography angiography (OCTA) en face image in the left eye. Outer retinal changes on optical coherence tomography (OCT) and a dense co-localised scotoma on a visual field (VF) examination confirmed the diagnosis of AMN, and the patient was started on a tapering dose of oral steroids. Improvement was seen in OCT, OCTA and VF during the 6-month follow-up visit. The use of OCTA en face imaging enabled the accurate identification of the lesion in the affected layers of the retina.
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Affiliation(s)
| | - Madhurima A Nayak
- Ophthalmology, Father Muller Medical College, Mangalore, Karnataka, India
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Feng H, Zhao M, Mo J, Cao X, Chen W, Wang H. The characteristics of acute macular neuroretinopathy following COVID-19 infection. BMC Ophthalmol 2024; 24:19. [PMID: 38200478 PMCID: PMC10782751 DOI: 10.1186/s12886-024-03283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/05/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND In this study, we report a case series of acute macular neuroretinopathy (AMN) associated with COVID-19 infection. METHODS This retrospective observational study was conducted at Beijing Tongren Hospital. We reviewed patients who were diagnosed with AMN within one month of testing positive for COVID-19 using real-time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS A total of 11 AMN patients (20 eyes) were included in the study. The mean age was 33.8 ± 12.6 years. The average interval between a positive COVID-19 PCR test and the onset of ocular symptoms was 2.8 ± 2.5 days. The mean follow-up period for the patients was 12.5 ± 3.8 weeks. Imaging characteristics of AMN patients following COVID-19 infection included areas of low reflectivity on near-infrared reflectance (NIR) imaging, hyperreflective lesions at the level of the outer plexiform layer (OPL) and outer nuclear layer (ONL) and disruption of the ellipsoid zone (EZ) on spectral domain optical coherence tomography (SD-OCT) B-scans. Visual field examinations revealed parafoveal scotomas that closely corresponded to the clinical lesions. Optical coherence tomography angiography (OCT-A) demonstrated impaired perfusion in the deep retinal vascular plexus. Fluorescein angiography (FA), indocyanine green angiography (ICGA), and spontaneous fundus autofluorescence showed no significant abnormalities. During follow-up, partial improvement in retinal lesions was observed in NIR imaging and SD-OCT in some patients, but a proportion of patients still exhibited persistent retinal damage and no improvement in visual field scotomas. CONCLUSION COVID-19-related AMN share similar clinical and imaging features with AMN due to other causes, as evidenced by the persistent presence of visual field scotomas over a longer duration. TRAIL REGISTRATION https://www.chictr.org.cn/ ; identifier: ChiCTR2100044365.
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Affiliation(s)
- Hui Feng
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, China
| | - Meng Zhao
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, China
| | - Jing Mo
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, China
| | - Xusheng Cao
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, China
| | - Weixin Chen
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, China
| | - Hong Wang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, China.
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Ikema S, Miura G, Shimizu D, Baba T. Long-term follow-up of a young male who developed acute macular neuroretinopathy following COVID-19 vaccination. Clin Case Rep 2023; 11:e8181. [PMID: 38028086 PMCID: PMC10645608 DOI: 10.1002/ccr3.8181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 12/01/2023] Open
Abstract
This report presents the clinical findings and prognosis of a healthy male patient who developed acute macular neuroretinopathy after COVID-19 vaccination. Abnormal findings improved about 1 month after the onset and disappeared 3 months later. The subjective symptoms disappeared in 3 months, and no recurrence was observed for 1 year.
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Affiliation(s)
- Shunsuke Ikema
- Department of Ophthalmology and Visual ScienceChiba University Graduate School of MedicineChibaJapan
| | - Gen Miura
- Department of Ophthalmology and Visual ScienceChiba University Graduate School of MedicineChibaJapan
| | - Daisuke Shimizu
- Department of Ophthalmology and Visual ScienceChiba University Graduate School of MedicineChibaJapan
| | - Takayuki Baba
- Department of Ophthalmology and Visual ScienceChiba University Graduate School of MedicineChibaJapan
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Miller CG, Brucker AJ, Perry LM, Kim BJ, Martin ME, Frey NV, Aleman TS. OUTER RETINOPATHY AND MICROANGIOPATHY IN ACUTE MYELOGENOUS LEUKEMIA. Retin Cases Brief Rep 2023; 17:683-689. [PMID: 37903306 DOI: 10.1097/icb.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
PURPOSE To describe a patient with acute myelogenous leukemia who presented with a recurrent, bilateral, outer retinopathy, before and after consolidative peripheral blood stem cell transplantation complicated by chronic graft-versus-host disease. METHODS This is a retrospective review of records from a 23-year-old woman with acute myelogenous leukemia who underwent comprehensive ophthalmic evaluations for over a year including chromatic perimetry and multifocal electroretinograms, imaging with spectral domain optical coherence tomography, near-infrared and short-wavelength fundus reflectance and autofluorescence, fluorescein and optical coherence tomography angiography. RESULTS The patient presented with recurrent, unilateral paracentral scotomas. There was localized loss of inner segment ellipsoid (EZ) and photoreceptor outer segment signals (IZ) in the pericentral retina of both eyes co-localizing with hyperreflective lesions on near-infrared reflectance. She subsequently lost vision (visual acuity = 20/200) in the right eye a year after consolidative peripheral blood stem cell transplantation complicated by steroid-resistant-chronic graft-versus-host disease. There was loss of the EZ and IZ signals corresponding to a dense central cone scotoma and multifocal electroretinograms depression. Near-infrared autofluorescence, fluorescein and optical coherence tomography angiography were within normal limits. Visual acuity (20/20) and retinal sensitivities improved with restoration of the EZ/IZ signals after oral prednisone and intravenous rituximab, but left a residual photoreceptor loss and paracentral scotoma. CONCLUSION We propose that an immune-mediated microangiopathy may explain the protracted, recurrent course of primary photoreceptor abnormalities in our patient, which was further complicated by manifestations of chronic graft-versus-host disease following consolidative peripheral blood stem cell transplantation. Outer retinal findings previously documented in leukemia may be explained by a similar mechanism.
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Affiliation(s)
- Charles G Miller
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Alexander J Brucker
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Linda M Perry
- Cell Therapy and Transplant Program, Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J Kim
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Mary Ellen Martin
- Cell Therapy and Transplant Program, Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noelle V Frey
- Cell Therapy and Transplant Program, Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tomas S Aleman
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Colcombe J, Mundae R, Kaiser A, Bijon J, Modi Y. Retinal Findings and Cardiovascular Risk: Prognostic Conditions, Novel Biomarkers, and Emerging Image Analysis Techniques. J Pers Med 2023; 13:1564. [PMID: 38003879 PMCID: PMC10672409 DOI: 10.3390/jpm13111564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Many retinal diseases and imaging findings have pathophysiologic underpinnings in the function of the cardiovascular system. Myriad retinal conditions, new imaging biomarkers, and novel image analysis techniques have been investigated for their association with future cardiovascular risk or utility in cardiovascular risk prognostication. An intensive literature search was performed to identify relevant articles indexed in PubMed, Scopus, and Google Scholar for a targeted narrative review. This review investigates the literature on specific retinal disease states, such as retinal arterial and venous occlusions and cotton wool spots, that portend significantly increased risk of future cardiovascular events, such as stroke or myocardial infarction, and the implications for personalized patient counseling. Furthermore, conditions diagnosed primarily through retinal bioimaging, such as paracentral acute middle maculopathy and the newly discovered entity known as a retinal ischemic perivascular lesion, may be associated with future incident cardiovascular morbidity and are also discussed. As ever-more-sophisticated imaging biomarkers and analysis techniques are developed, the review concludes with a focused analysis of optical coherence tomography and optical coherence tomography angiography biomarkers under investigation for potential value in prognostication and personalized therapy in cardiovascular disease.
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Affiliation(s)
- Joseph Colcombe
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA; (J.C.); (R.M.)
| | - Rusdeep Mundae
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA; (J.C.); (R.M.)
| | - Alexis Kaiser
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jacques Bijon
- Vitreous Retina Macula Consultants of New York, New York, NY 10022, USA;
| | - Yasha Modi
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA; (J.C.); (R.M.)
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Bellur S, Zeleny A, Patronas M, Jiramongkolchai K, Kodati S. Bilateral Acute Macular Neuroretinopathy after COVID-19 Vaccination and Infection. Ocul Immunol Inflamm 2023; 31:1222-1225. [PMID: 35914286 DOI: 10.1080/09273948.2022.2093753] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/09/2022] [Accepted: 06/13/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To describe a case of acute macular neuroretinopathy (AMN) in a patient with recent COVID-19 vaccination and infection who demonstrated atypical features on presentation. OBSERVATIONS A 64-year-old woman presented with central vision loss in both eyes (OU). She had recently received the Moderna COVID-19 vaccine and rapidly developed systemic symptoms. Testing revealed COVID-19 infection. Visual acuities were 20/200 OU and near-infrared reflectance revealed hypo-reflective lesions in the maculae OU, optical coherence tomography (OCT) showed outer nuclear layer thinning and ellipsoid zone disruption OU, and OCT-angiography showed flow voids in the deep capillary plexus and choriocapillaris OU, all consistent with AMN. She was treated with oral prednisone with subsequent mild vision improvement and persistent scotomas. DISCUSSION COVID-19 associated AMN can present with a more severe clinical presentation than classically seen in AMN. Ischemic and inflammatory changes due to COVID-19 infection may contribute to this more advanced presentation.
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Affiliation(s)
- Sunil Bellur
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander Zeleny
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Marena Patronas
- Department of Ophthalmology, George Washington University, Washington, District of Columbia, USA
| | | | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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Strzalkowski P, Steinberg JS, Dithmar S. [COVID-19-associated acute macular neuroretinopathy]. DIE OPHTHALMOLOGIE 2023; 120:767-770. [PMID: 35943530 PMCID: PMC9361229 DOI: 10.1007/s00347-022-01704-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- P Strzalkowski
- Augenklinik Wiesbaden, Helios HSK Wiesbaden, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland.
| | - J S Steinberg
- Augenklinik Wiesbaden, Helios HSK Wiesbaden, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland
| | - S Dithmar
- Augenklinik Wiesbaden, Helios HSK Wiesbaden, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland
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Afonso MG, Marques JH, Monteiro S, Lume M, Abreu AC, Maia S. ACUTE MACULAR NEURORETINOPATHY FOLLOWING SARS-CoV-2 VACCINATION. Retin Cases Brief Rep 2023; 17:438-440. [PMID: 37364205 DOI: 10.1097/icb.0000000000001222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
PURPOSE To report a case of acute macular neuroretinopathy (AMN) following SARS-CoV-2 vaccination. METHODS Case report. RESULTS An otherwise healthy 28-year-old white woman presented to an ophthalmology department with complaints of black paracentral vision scotomata on both eyes that appeared 2 days after receiving the first dose of Vaxzevria vaccine. Fundus examination revealed bilateral red brown petaloid lesions around the fovea. On spectral domain optical coherence tomography, a hyperreflective plaque between the outer plexiform and outer nuclear layers along with disruption of ellipsoid zone/interdigitation zone was observed. A diagnosis of AMN was made. CONCLUSION AMN may be an extremely rare adverse event of SARS-COV-2 vaccination, especially in patients with other risk factors. SYNOPSIS An otherwise healthy 28-year-old white woman was diagnosed with AMN 2 days after SARS-CoV-2 vaccination.
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Affiliation(s)
| | - João Heitor Marques
- Centro Hospitalar Universitário do Porto- Hospital de Santo António, Oporto, Portugal; and
| | | | - Miguel Lume
- Centro Hospitalar Universitário do Porto- Hospital de Santo António, Oporto, Portugal; and
| | - Ana Carolina Abreu
- Centro Hospitalar Universitário do Porto- Hospital de Santo António, Oporto, Portugal; and
| | - Sofia Maia
- Centro Hospitalar Universitário do Porto- Hospital de Santo António, Oporto, Portugal; and
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Agarwal A, Pichi F, Invernizzi A, Grewal DS, Singh RB, Upadhyay A. Stepwise approach for fundus imaging in the diagnosis and management of posterior uveitis. Surv Ophthalmol 2023; 68:446-480. [PMID: 36724831 DOI: 10.1016/j.survophthal.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
An array of retinochoroid imaging modalities aid in comprehensive evaluation of the immunopathological changes in the retina and choroid, forming the core component for the diagnosis and management of inflammatory disorders such as uveitis. The recent technological breakthroughs have led to the development of imaging platforms that can evaluate the layers of retina and choroid and the structural and functional alteration in these tissues. Ophthalmologists heavily rely on imaging modalities such as dye-based angiographies (fluorescein angiography and indocyanine green angiography), optical coherence tomography, fundus autofluorescence, as well as dye-less angiography such as optical coherence tomography angiograph,y for establishing a precise diagnosis and understanding the pathophysiology of the diseases. Furthermore, these tools are now being deployed with a 'multimodal' approach for swift and accurate diagnosis. In this comprehensive review, we outline the imaging platforms used for evaluation of posterior uveitis and discuss the organized, algorithmic approach for the assessment of the disorders. Additionally, we provide an insight into disease-specific characteristic pathological changes and the established strategies to rule out disorders with overlapping features on imaging.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, New South Wales, Australia
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Awaneesh Upadhyay
- Department of Ophthalmology, EyeQ Super-specialty Hospitals, Noida, Uttar Pradesh, India
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Rajurkar K, Thakar M. Optical coherence tomography angiography features of dengue retinopathy manifesting as acute macular neuroretinopathy, branch vein vasculitis and neurosensory detachment. Oman J Ophthalmol 2023; 16:177-179. [PMID: 37007231 PMCID: PMC10062082 DOI: 10.4103/ojo.ojo_210_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/24/2021] [Accepted: 08/20/2021] [Indexed: 02/23/2023] Open
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Radwan LM, Bou Ghanem GO, Daye GN, Ghazi NG. Acute macular neuroretinopathy associated with intravitreal anti-VEGF injection: A case report. Am J Ophthalmol Case Rep 2022; 28:101687. [PMID: 36046518 PMCID: PMC9421172 DOI: 10.1016/j.ajoc.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/25/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose to report a case of acute macular neuroretinopathy occurring after intravitreal aflibercept injection for macular edema due to CRVO. Observations Two days after Aflibercept intravitreal injection, the patient developed vision loss associated with a central scotoma. Optical coherence tomography showed a hyperreflective band at the level of the outer nuclear/outer plexiform layer corresponding to the patient's scotoma, ruling in the diagnosis of acute macular neuroretinopahty. Even though the OCT abnormalities resolved spontaneously, only partial resolution of the scotoma was observed 4 months later. Conclusions and importance Acute macular neuroretinopathy might be associated with intravitreal anti-VEGF injection.
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15
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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16
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Acute macular neuroretinopathy after COVID-19 vaccine. J Fr Ophtalmol 2022; 45:e299-e302. [PMID: 35717218 PMCID: PMC9130638 DOI: 10.1016/j.jfo.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 11/23/2022]
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17
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Association of Paracentral Acute Middle Maculopathy with Visual Prognosis in Retinal Artery Occlusion: A Retrospective Cohort Study. J Ophthalmol 2022; 2022:9404973. [PMID: 35637681 PMCID: PMC9148221 DOI: 10.1155/2022/9404973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background The association between paracentral acute middle maculopathy (PAMM) and visual acuity in patients with retinal artery occlusion (RAO) is unknown. This study explored the clinical features and prognostic factors for visual acuity of RAO accompanied by PAMM. Methods This retrospective study included patients with RAO who underwent FFA and OCT examinations at Shenzhen Eye Hospital from July 2015 to June 2019. The changes in vision and macular structure were observed. Results Eighty-eight patients were included. There were 58 patients (65.9%) with central RAO (CRAO) and 30 (34.1%) with branch RAO (BRAO). Fifty-two eyes were diagnosed with PAMM, of which 33 eyes (63.5%) were from CRAO patients and 19 (36.5%) were from BRAO patients. At diagnosis, the PAMM group had significantly better logMAR BCVA values than the no-PAMM group (median (IQR), 1.35 (0.725–2) vs. 2.15 (1.47–2.3), P=0.002). In addition, the PAMM group had significantly better logMAR BCVA values during follow-up than the no-PAMM group (median (IQR), 1 (0.05–2) vs. 2 (1.15–2.3), P=0.001). After adjustment for age, gender, CRAO/BRAO, comorbidities, and symptom duration, PAMM was associated with good visual acuity improvement (RR = 3.29, 95% CI: 1.29–8.37, P=0.013). Conclusion PAMM was associated with good visual acuity improvement during follow-up in patients with RAO.
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18
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Pradas M, Rodriguez-Merchante MP, Estébanez N, Sarraf D, Freund KB, Fawzi A, Pichi F, Carreño E. Navigating the White Dot Syndromes with Optical Coherence Tomography (OCT) and OCT Angiography (OCT-A). Ocul Immunol Inflamm 2022; 30:664-674. [PMID: 35412934 DOI: 10.1080/09273948.2022.2046798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION White dot syndromes are a heterogeneous group of diseases that affect different layers in the retina and choroid. Multimodal imaging is fundamental in the diagnosis, but also can be crucial in unveiling the pathogenesis of these entities. MATERIAL AND METHODS Literature review. RESULTS Optical coherence tomography (OCT) provides depth-resolved, histological grade images of the vitreous, retina, and choroid. This technology is very useful to localize the primary nature and level of pathology of the various white dot syndromes. En face OCT can provide additional information regarding the interrelationship of lesion types. Vascular involvement at the level of the retina, choriocapillaris or choroid can be assessed by en face OCT angiography (OCT-A) and is not limited by masking, leakage or staining as can occur with conventional angiography (fluorescein or indocyanine green angiography) which requires dye injection. CONCLUSION OCT and OCTA are fundamental in the diagnosis and follow-up of white dots syndromes.
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Affiliation(s)
- Marta Pradas
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | - Nuria Estébanez
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, USA
| | - Amani Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Francesco Pichi
- Department of Ophthalmology, Cleveland Clinic, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Ester Carreño
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
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19
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Franchi A, Rauchegger T, Palme C, Frede K, Haas G, Blatsios G, Kralinger M, Zehetner C. Two Cases of Acute Macular Neuroretinopathy Associated with the Adenovirus-based COVID-19 Vaccine Vaxzevria (Astrazeneca). Ocul Immunol Inflamm 2022; 30:1234-1239. [PMID: 35050829 DOI: 10.1080/09273948.2022.2027463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report two cases of acute macular neuroretinopathy (AMN) in young female patients following the administration of the adenovirus-based coronavirus disease 2019 (COVID-19) vaccine Vaxzevria (AstraZeneca). METHODS Spectral-domain optical coherence tomography and infrared imaging were used to confirm the diagnosis of AMN. RESULTS Both patients showed a parafoveal hyperreflective band in the outer nuclear layer, disruption of the ellipsoid and interdigitation zones of the photoreceptor layers, and correlating hyporeflective areas on the near-infrared images. Both patients presented with flu-like fever and sudden onset of fortifications within 48 hours of vaccination. One patient showed altered flow in the deep capillary plexus and highly elevated thrombotic parameters. CONCLUSION We report a possible association between immune-mediated AMN and the administration of adenovirus-based COVID-19 vaccine Vaxzevria.
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Affiliation(s)
- Alexander Franchi
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Teresa Rauchegger
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Palme
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Katharina Frede
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Gertrud Haas
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Georgios Blatsios
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Martina Kralinger
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Claus Zehetner
- Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
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20
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Sanjay S, Gadde SGK, Kumar Yadav N, Kawali A, Gupta A, Shetty R, Mahendradas P. "Bilateral Sequential Acute Macular Neuroretinopathy in an Asian Indian Female with β Thalassemia Trait following (Corona Virus Disease) COVID-19 Vaccination and Probable Recent COVID Infection- Multimodal Imaging Study.". Ocul Immunol Inflamm 2022; 30:1222-1227. [PMID: 35050826 DOI: 10.1080/09273948.2022.2026978] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Corona virus disease (COVID-19) has been associated with a variety of ophthalmic manifestations including acute macular neuroretinopathy and paracentral middle maculopathy. Posterior segment manifestations after post COVID-19 vaccinations have been reported. CASE REPORT A 25- year-old Asian Indian female developed sequential bilateral AMN following a single dose of COVISHIELD™ vaccine. On investigations she was found to have a β thalassemia trait. Presentation started unilaterally and progressed to the other eye after a month. On clinical examination, the fundus was apparently normal in both eyes. Significant changes suggestive of AMN were seen on multimodal imaging of the posterior segment of the respective eye at the time of involvement which resolved spontaneously in due course. CONCLUSION We report a temporal association of COVID-19 vaccination and AMN.
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Affiliation(s)
- Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | | | | | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Aditi Gupta
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Neuro-ophthalmology, Narayana Nethralaya, Bangalore, India
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21
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David JA, Fivgas GD. Acute macular neuroretinopathy associated with COVID-19 infection. Am J Ophthalmol Case Rep 2021; 24:101232. [PMID: 34778601 PMCID: PMC8577875 DOI: 10.1016/j.ajoc.2021.101232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/30/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose To report a case of bilateral acute macular neuroretinopathy (AMN) associated with a COVID-19 infection. Observations A 22-year-old female was referred for evaluation of bilateral scotomas concurrent with a mildly symptomatic COVID-19 infection. Exam showed normal visual acuity, bilateral reddish-brown petaloid retinal lesions which were hyporeflective on near infrared (NIR) optical coherence tomography (OCT), and had associated hypoperfusion of the deep vascular plexus on OCT-angiography (OCT-A) consistent with bilateral AMN. At follow-up, scotomas and retinal findings on near infrared imaging and spectral-domain optical coherence tomography had only slightly improved. Conclusions COVID-19 has been documented to be the etiology of a growing number of ocular manifestations including microvascular events. We report a case of bilateral acute macular neuroretinopathy in a patient with a recent diagnosis of COVID-19 infection that had persistent symptoms and findings at six month follow-up.
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Affiliation(s)
- James A David
- Louisiana State University Health Sciences Center, Department of Ophthalmology, 533 Bolivar St, Room 451B, New Orleans, LA, 70112, USA
| | - George D Fivgas
- Louisiana State University Health Sciences Center, Department of Ophthalmology, 533 Bolivar St, Room 451B, New Orleans, LA, 70112, USA.,The Retina Center, 7777 Hennessy Blvd, Ste 3000, Baton Rouge, LA, 70808, USA
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22
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Azar G, Bonnin S, Vasseur V, Faure C, Salviat F, Clermont CV, Titah C, Farès S, Boulanger E, Derrien S, Couturier A, Duvilliers A, Manassero A, Hage R, Tadayoni R, Behar-Cohen F, Mauget-Faÿsse M. Did the COVID-19 Pandemic Increase the Incidence of Acute Macular Neuroretinopathy? J Clin Med 2021; 10:jcm10215038. [PMID: 34768555 PMCID: PMC8585041 DOI: 10.3390/jcm10215038] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Acute macular neuroretinopathy (AMN) is an increasingly diagnosed disorder associated with several diseases. The aim of this study was to report the incidence of AMN cases diagnosed during the 2020 coronavirus disease 2019 (COVID-19) pandemic year in a French hospital, and to describe their different forms. Methods: All patients diagnosed between 2019 and 2020, in Paris Rothschild Foundation Hospital, with AMN, paracentral acute middle maculopathy (PAMM) and multiple evanescent white dot syndrome (MEWDS) were retrospectively collected using the software Ophtalmoquery® (Corilus, V1.86.0018, 9050 Gand, Belgium). Systemic and ophthalmological data from AMN patients were analyzed. Results: Eleven patients were diagnosed with AMN in 2020 vs. only one patient reported in 2019. The incidence of AMN significantly increased from 0.66/100,000 visits in 2019 to 8.97/100,000 visits in 2020 (p = 0.001), whereas the incidence of PAMM and MEWDS remained unchanged. Four (36%) of these AMN patients were tested for COVID-19 and received positive polymerase chain reaction (PCR) tests. Conclusions: The incidence of AMN cases increased significantly in our institution in 2020, which was the year of the COVID-19 pandemic. All AMN-tested patients received a positive COVID PCR test, suggesting a possible causative link. According to the different clinical presentations, AMN may reflect different severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pathogenic mechanisms.
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Affiliation(s)
- Georges Azar
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Anterior Segment Department, Adolphe de Rothschild Foundation, 75019 Paris, France
- Correspondence:
| | - Sophie Bonnin
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Vivien Vasseur
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Céline Faure
- Ramsay Générale de Santé, Private Hospital Saint Martin, 14000 Caen, France;
| | - Flore Salviat
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Catherine Vignal Clermont
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Cherif Titah
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Anterior Segment Department, Adolphe de Rothschild Foundation, 75019 Paris, France
| | - Selim Farès
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Anterior Segment Department, Adolphe de Rothschild Foundation, 75019 Paris, France
| | - Elise Boulanger
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Sabine Derrien
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Aude Couturier
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Ophthalmology Department, Lariboisière Hospital—Assistance Publique-Hôpitaux de Paris, AP-HP, 75010 Paris, France
| | - Amélie Duvilliers
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Anthony Manassero
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Rabih Hage
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Ramin Tadayoni
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Ophthalmology Department, Lariboisière Hospital—Assistance Publique-Hôpitaux de Paris, AP-HP, 75010 Paris, France
| | - Francine Behar-Cohen
- Ophthalmology Department, OphtalmoPôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, 75014 Paris, France;
- Centre de Recherche des Cordeliers, Team 17, INSERM U1138, Université de Paris, 75006 Paris, France
| | - Martine Mauget-Faÿsse
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
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23
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Vinzamuri S, Pradeep TG, Kotian R. Bilateral paracentral acute middle maculopathy and acute macular neuroretinopathy following COVID-19 vaccination. Indian J Ophthalmol 2021; 69:2862-2864. [PMID: 34571652 PMCID: PMC8597515 DOI: 10.4103/ijo.ijo_1333_21] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 35-year-old male patient presented with blurring and black spots in vision after 1 month of the second dose of Covishield vaccination. His visual acuity was 6/6; both eyes and anterior and posterior segment examinations were normal. The optical coherence tomography (OCT) showed multiple hyperreflective lesions involving the nerve fiber layer with back shadowing. In addition, there were hyperreflective spots in the ganglion cell layer and outer plexiform layer with focal loss of external limiting membrane and an intact inner segment/outer segment junction involving the posterior pole in both eyes. The patient was diagnosed with paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) and advised observation. PAMM and AMN are unreported manifestations following the COVID-19 vaccination.
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Affiliation(s)
| | | | - Rachana Kotian
- Department of Ophthalmology, Ramaiah Medical College, Bangalore, Karnataka, India
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24
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Drüke D, Pleyer U, Hoerauf H, Feltgen N, Bemme S. Acute macular neuroretinopathy (AMN) following COVID-19 vaccination. Am J Ophthalmol Case Rep 2021; 24:101207. [PMID: 34580648 PMCID: PMC8457905 DOI: 10.1016/j.ajoc.2021.101207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/14/2021] [Accepted: 09/20/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To describe a case of acute macular neuroretinopathy (AMN) in a 23-year-old Caucasian female after a COVID-19 vaccination (Vaxzevira). Observations Our patient perceived visual symptoms in both eyes one day after COVID-19 vaccination. Hyporeflective petalloid shaped perifoveal lesions appeared in infrared reflectance (IR) imaging, and Spectral domain-optical coherence tomography (SD-OCT) revealed structural alterations of outer retinal layers that resulted in persistent disruption of the ellipsoid zone (EZ) and the interdigitation zone (IZ). Conclusions and importance We report a novel association between AMN and COVID-19 vaccination. In addition to a febrile infection and oral contraception, previous vaccination should also be considered a potential risk factor for AMN.
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Affiliation(s)
- Daniela Drüke
- University Medical Center Goettingen, Department of Ophthalmology, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Uwe Pleyer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Ophthalmology, Campus Virchow, Charité, 13353, Berlin, Germany
| | - Hans Hoerauf
- University Medical Center Goettingen, Department of Ophthalmology, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Nicolas Feltgen
- University Medical Center Goettingen, Department of Ophthalmology, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Sebastian Bemme
- University Medical Center Goettingen, Department of Ophthalmology, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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25
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Mc Cabe GA, Campbell WG, Campbell TG. Acute Macular Neuroretinopathy Related to Alcoholic Hepatitis. Case Rep Ophthalmol 2021; 12:293-298. [PMID: 34054473 PMCID: PMC8138200 DOI: 10.1159/000513186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/19/2020] [Indexed: 11/21/2022] Open
Abstract
A 33-year-old woman admitted for acute alcoholic hepatitis was referred to the ophthalmology department with an acute onset paracentral scotoma of the left eye. On examination, best-corrected visual acuity was Snellen 6/4 in the right eye and 6/9 in the left eye. Dilated left fundus examination revealed wedge-shaped changes at the macula. Spectral-domain ocular coherence tomography (SD-OCT) initially revealed a small cuff of subfoveal fluid and band-like hyperreflectivity extending outwards from the outer plexiform layer consistent with acute macular neuroretinopathy (AMN). Four days later, repeat SD-OCT was performed and it demonstrated resolution of the subfoveal fluid and disruption of the outer retinal layers. At the 6-week follow-up, the patient had no improvement in her symptoms and OCT angiography demonstrated coarsening and microvascular changes in both the deep vascular plexus and the choriocapillaris. To our knowledge, this is the first case of AMN in association with acute hepatitis. Although the exact pathophysiology of AMN remains obscure, this case highlights the benefits of multimodal retinal imaging and aims to bring attention to the possible association of AMN with alcoholic hepatitis.
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Affiliation(s)
- Grace Anne Mc Cabe
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - William Gordon Campbell
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Thomas Gordon Campbell
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Centre for Eye Research Australia, East Melbourne, Victoria, Australia
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26
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Acute macular neuroretinopathy in a case of chronic lymphocytic leukemia. Can J Ophthalmol 2021; 56:e166-e168. [PMID: 33775612 DOI: 10.1016/j.jcjo.2021.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/19/2021] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
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27
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Thakar SD, Hassan OM, Gill MK. Acute macular neuroretinopathy associated with acute promyelocytic leukemia. Am J Ophthalmol Case Rep 2021; 22:101044. [PMID: 33718659 PMCID: PMC7933699 DOI: 10.1016/j.ajoc.2021.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/11/2020] [Accepted: 02/20/2021] [Indexed: 11/03/2022] Open
Abstract
Purpose To describe the first reported case of acute macular neuroretinopathy (AMN) associated with acute promyelocytic leukemia in a young Asian-Indian male. Observations We review the clinical and multimodal imaging findings in our patient that are characteristic of AMN. Conclusions and importance Ophthalmologists should be aware of the association of leukemia with AMN and consider hematologic work-up when assessing patients with AMN without the prototypical history or risk factors.
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Affiliation(s)
- Sudip D Thakar
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Omar M Hassan
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Manjot K Gill
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Liu Y, Haq Z, Pasricha ND, Bever GJ. Acute Macular Neuroretinopathy Associated With an Oral FLT3 Inhibitor. JAMA Ophthalmol 2021; 138:1104-1106. [PMID: 32761105 DOI: 10.1001/jamaophthalmol.2020.2815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yingna Liu
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Zeeshan Haq
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Neel D Pasricha
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Greg J Bever
- Department of Ophthalmology, University of California, San Francisco, San Francisco.,Retina Service, University of California, San Francisco, San Francisco
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Zamani G, Ataei Azimi S, Aminizadeh A, Shams Abadi E, Kamandi M, Mortazi H, Shariat S, Abrishami M. Acute macular neuroretinopathy in a patient with acute myeloid leukemia and deceased by COVID-19: a case report. J Ophthalmic Inflamm Infect 2021; 10:39. [PMID: 33415590 PMCID: PMC7790518 DOI: 10.1186/s12348-020-00231-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Acute macular neuroretinopathy (AMN) is a visual-deteriorating rare clinical entity with an uncertain etiology. We aimed to report a case of AMN and underlying disease of acute myeloid leukemia (AML). CASE PRESENTATION A thirty-five-year-old female patient with bone marrow biopsy confirmed AML, and bicytopenia, under chemotherapy, complained of sudden paracentral visual field defect in her right eye was referred. Visual acuity was 20/20 in both eyes. Posterior segment evaluation revealed multiple Roth's spots. Optical coherence tomography (OCT) demonstrated hyper-reflectivity band, in the outer nuclear layer and outer plexiform layer, nasal to the fovea of the right eye, and hyperreflective patch in outer retina segmentation en-face OCT, suggestive of the diagnosis of AMN. Nine days after AMN diagnosis, dyspnea, malaise, and cough was initiated. Ground glass opacities in lung CT scan, beside reverse transcription polymerase chain reaction of severe acute respiratory syndrome coronavirus-2, was conclusive of coronavirus disease 2019 (COVID-19). The patient deceased after 6 days. CONCLUSION We report a rare case of AMN following AML. Our findings support the role of ischemia in the outer retina, of which AML may contributed to the pathophysiological process. The patient has deceased less than 2 weeks from AMN initiation.
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Affiliation(s)
- Ghodsieh Zamani
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Ataei Azimi
- Department of Hematology-Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Aminizadeh
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Shams Abadi
- Department of Hematology-Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Kamandi
- Department of Hematology-Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hasan Mortazi
- Department of Hematology-Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Shariat
- Department of Hematology-Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Qarani Blvd, Mashhad, 9195965919, Iran.
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30
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Vascular abnormalities in uveitis. Surv Ophthalmol 2021; 66:653-667. [PMID: 33412171 DOI: 10.1016/j.survophthal.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
Inflammation can involve several ocular structures, including the sclera, retina, and uvea, and cause vascular changes in these tissues. Although retinal vasculitis is the most common finding associated with uveitis involving the posterior segment, other vascular abnormalities may be seen in the retina. These include capillary nonperfusion and ischemia, vascular occlusions, preretinal neovascularization, microaneurysms and macroaneurysms, and telangiectasia. Moreover, vasoproliferative tumors and subsequent coat-like response can develop secondary to uveitis. Fluorescein angiography is ideal for the investigation of retinal vascular leakage and neovascularization, while optical coherence tomography angiography can provide depth resolved images from the superficial and deep capillary plexus and can demonstrate vascular remodeling. Choroidal vascular abnormalities primarily develop in the choriocapillaris or in the choroidal stroma and can appear as flow void in optical coherence tomography angiography and filling defect and vascular leakage in indocyanine green angiography. Extensive choriocapillaris nonperfusion in the presence of choroidal inflammation can increase the risk of choroidal neovascular membrane development. Iris vascular changes may manifest as dilation of vessels in stroma due to inflammation or rubeosis that is usually from ischemia in retinal periphery secondary to chronic inflammation. More severe forms of scleral inflammation, such as necrotizing scleritis, are associated with vascular occlusion in the deep episcleral plexus, which can lead to necrosis of sclera layer and uveal exposure.
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Sonne SJ, Smith BT. Incidence of uveitis and macular edema among patients taking fingolimod 0.5 mg for multiple sclerosis. J Ophthalmic Inflamm Infect 2020; 10:24. [PMID: 32954456 PMCID: PMC7502642 DOI: 10.1186/s12348-020-00215-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background Patients with multiple sclerosis (MS) have a higher incidence of uveitis compared with the general population. Fingolimod, a first line disease modifying drug used in multiple sclerosis, may cause macular edema and thus requires ophthalmic examination. However, murine models and anecdotal reports suggest fingolimod may reduce the incidence of uveitis. Purpose To report the incidence of uveitis and macular edema among those on fingolimod 0.5 mg (Gilenya®) therapy for multiple sclerosis (MS). Methods Retrospective review of patients on fingolimod who developed uveitis and/or macular edema. Results No patients had an occurrence or history of uveitis. Four of the 188 (2.13%) patients developed macular edema without ocular inflammation. One of the 188 (0.53%) patients developed Acute Macular Neuroretinopathy. Conclusion Patients taking fingolimod have a lower incidence of uveitis than expected in a population of MS patients.
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Affiliation(s)
| | - Bradley Thomas Smith
- The Retina Institute in St. Louis, 2201 S Brentwood Blvd, St. Louis, MO, 63144, USA. .,Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, USA.
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Mahendradas P, Kawali A, Luthra S, Srinivasan S, Curi AL, Maheswari S, Ksiaa I, Khairallah M. Post-fever retinitis - Newer concepts. Indian J Ophthalmol 2020; 68:1775-1786. [PMID: 32823394 PMCID: PMC7690479 DOI: 10.4103/ijo.ijo_1352_20] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/09/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
Post-fever retinitis (PFR) is an infectious or para-infectious uveitic entity caused by bacterial or viral agents and seen mainly in tropical countries. Systemic symptoms such as joint pain, skin rash are common during the febrile stage. On the basis of only clinical presentation, it is difficult to pin-point the exact etiology for PFR. Serological investigations, polymerase chain reaction, and knowledge of concurrent epidemics in the community may help to identify the etiological organism. Bacterial causes of PFR such as rickettsia and typhoid are treated with systemic antibiotics, with or without systemic steroid therapy, whereas PFR of viral causes such as chikungunya, dengue, West Nile virus, and Zika virus have no specific treatment and are managed with steroids. Nevertheless, many authors have advocated mere observation and the uveitis resolved with its natural course of the disease. In this article, we have discussed the clinical features, pathogenesis, investigations, and management of PFR.
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Affiliation(s)
- Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | | | - Sanjay Srinivasan
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Andre L Curi
- National Institute of Infectious Diseases-INI-FIOCRUZ, Rio de Janeiro – Brazil
| | | | - Imen Ksiaa
- Department of Ophthalmology, FattoumaBourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, FattoumaBourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Zhang YS, Lee HE, Kwan CC, Schwartz GW, Fawzi AA. Caffeine Delays Retinal Neurovascular Coupling during Dark to Light Adaptation in Healthy Eyes Revealed by Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2020; 61:37. [PMID: 32340030 PMCID: PMC7401906 DOI: 10.1167/iovs.61.4.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to investigate the acute effects of caffeine on retinal hemodynamics during dark to light adaptation using optical coherence tomography angiography (OCTA). Methods Thirteen healthy individuals (13 eyes) underwent OCTA imaging after dark adaptation and at repeated intervals during the transition to ambient light in two imaging sessions: control and after ingesting 200 mg of caffeine. We analyzed the parafoveal vessel density (VD) and adjusted flow index (AFI) of the superficial capillary plexus (SCP), middle capillary plexus (MCP), and deep capillary plexus (DCP), as well as the vessel length density (VLD) of the SCP. After adjusting for age, refractive error, and scan quality, we compared parameters between control and caffeine conditions. Results In the dark, MCP VD decreased significantly after caffeine (−2.63 ± 1.28%). During the transition to light, initially, DCP VD increased (12.55 ± 2.52%), whereas SCP VD decreased (−2.09 ± 0.91%) significantly with caffeine compared to control. By 15 minutes in light, DCP VD reversed and was significantly decreased (−5.45 ± 2.62%), whereas MCP VD increased (4.65 ± 1.74%). There were no differences in AFI or VLD. Conclusions We show that, overall, caffeine causes a trend of delayed vascular response in all three macular capillary plexuses in response to ambient light. Whereas the MCP is constricted in the dark, during the transition from dark to light, there is initially delay followed by prolonged constriction of the DCP and constriction followed by slow dilation of the SCP. We posit that these delayed vascular responses may present potential risk of capillary ischemia.
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Scharf J, Freund KB, Sadda S, Sarraf D. Paracentral acute middle maculopathy and the organization of the retinal capillary plexuses. Prog Retin Eye Res 2020; 81:100884. [PMID: 32783959 DOI: 10.1016/j.preteyeres.2020.100884] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
The retinal capillary vasculature serves the formidable role of supplying the metabolically active inner and middle retina. In the parafoveal region, the retinal capillary plexuses (RCP) are organized in a system of three capillary layers of varying retinal depths: the superficial capillary plexus (SCP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). While the dynamic flow through these plexuses is complex and not completely understood, current research points to a hybrid model that includes both parallel and in series components in which blood flows in a predominantly serial direction between the superficial vascular complex (SVC) and deep vascular complex (DVC). Each capillary plexus autoregulates independently, so that under most conditions the retinal vasculature supplies adequate blood flow and oxygen saturation at varying depths despite diverse environmental stressors. When the flow in the deep vascular complex (i.e. ICP and DCP) fails, an ischemic lesion referred to as Paracentral Acute Middle Maculopathy (PAMM) can be identified. PAMM is an optical coherence tomography (OCT) finding defined by the presence of a hyperreflective band at the level of the inner nuclear layer (INL) that indicates INL infarction caused by globally impaired perfusion through the retinal capillary system leading to hypoperfusion of the DVC or specifically the DCP. Patients present with an acute onset paracentral scotoma and typically experience a permanent visual defect. Lesions can be caused by a diverse set of local retinal vascular diseases and systemic disorders. PAMM is a manifestation of the retinal ischemic cascade in which the mildest forms of ischemia develop at the venular end of the DCP, i.e. perivenular PAMM, while more severe forms progress horizontally to diffusely involve the INL, and the most severe forms progress vertically to infarct the inner retina. Management is targeted toward the identification and treatment of related vasculopathic and systemic risk factors.
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Affiliation(s)
- Jackson Scharf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - K Bailey Freund
- Retina Department, Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States.
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35
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Optical coherence tomography diagnostic signs in posterior uveitis. Prog Retin Eye Res 2020; 75:100797. [DOI: 10.1016/j.preteyeres.2019.100797] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
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Rajabian F, Arrigo A, Bordato A, Mercuri S, Bandello F, Battaglia Parodi M. Optical Coherence Tomography Angiography in Extensive Macular Atrophy with Pseudodrusen-Like Appearance. Transl Vis Sci Technol 2020; 9:2. [PMID: 32704422 PMCID: PMC7347281 DOI: 10.1167/tvst.9.3.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Analyses of quantitative features of optical coherence tomography angiography (OCTA) in patients affected by extensive macular atrophy with pseudodrusen-like appearance (EMAP). Methods In a prospective case-control study, patients and age- and gender-matched healthy controls underwent complete ophthalmologic examination, including best corrected visual acuity (BCVA) measurement, biomicroscopy, fundus autofluorescence and spectral-domain optical coherence tomography (Spectralis HRA; Heidelberg Engineering GmbH, Heidelberg, Germany), and OCTA scans (DRI OCT Triton; Topcon Corporation, Tokyo, Japan). Vessel density in the superficial capillary plexus and deep capillary plexus (DCP) in the retina and choriocapillaris (CC) in the macula and optic disc were measured. The one-way analysis of variance test with Bonferroni correction was used for statistical assessments. Results Seven patients (14 eyes) and 10 controls were included in the study. The mean follow-up period was 3 ± 0.8 years. The mean BCVA of patients at baseline was 0.81 ± 0.43 (logarithm of the minimum angle of resolution [LogMAR]) and 1.05 ± 0.38 (LogMAR) at the final follow-up visit (P = 0.006). Quantitative analyses of retinal vessels revealed significant alterations, especially in the DCP and CC, in both atrophic and junctional zones in retina of EMAP patients compared with preserved zones and controls. Conclusions OCTA analysis characterized three different retinal regions in EMAP disease, corresponding to progressively deeper perfusion defects. Further investigations are warranted to explore the correlation between DCP changes and the extension of atrophy. Translational Relevance By expanding our pilot study, we may better define EMAP on the basis of vascular changes and eventually recognize earlier the direction of enlargement of atrophy by means of OCTA analyses.
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Affiliation(s)
- Firuzeh Rajabian
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Alessandro Bordato
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Stefano Mercuri
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Özmert E, Arslan U. Management of Deep Retinal Capillary Ischemia by Electromagnetic Stimulation and Platelet-Rich Plasma: Preliminary Clinical Results. Adv Ther 2019; 36:2273-2286. [PMID: 31385285 DOI: 10.1007/s12325-019-01040-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION To investigate the efficacy of retinal electromagnetic stimulation and sub-tenon autologous platelet-rich plasma in the treatment of deep retinal capillary ischemia. METHODS The study included 28 eyes of 17 patients aged 15-76 years (mean 37.9 years) who had deep retinal capillary ischemia. Patients who had acute-onset paracentral scotoma in the last 1 month were included in the study between January 2018 and January 2019. The diagnosis of deep retinal capillary ischemia was based on clinical history and typical findings of optical coherence tomography angiography. The eyes were divided into three groups: group 1 (n = 7 eyes) received electromagnetic stimulation alone; group 2 (n = 7 eyes) received electromagnetic stimulation and sub-tenon autologous platelet-rich plasma injection; group 3 had no intervention and served as a control group (n = 14 eyes). The patients underwent ten sessions of electromagnetic stimulation in groups 1 and 2. Sub-tenon autologous platelet-rich plasma injection was performed immediately after the first, fifth, and tenth sessions of electromagnetic stimulation in group 2. The deep retinal capillary density and best corrected visual acuity changes were investigated before and after treatment at the first month. RESULTS The mean deep retinal capillary density was 52.0% before electromagnetic stimulation and 56.1% after ten sessions of application in group 1; this improvement was statistically significant (p = 0.01). In the combined treatment group (group 2), the mean deep retinal capillary density was 46.9% before the treatment and 56.5% after the treatment; this increase was also statistically significant (p = 0.01). Statistically significant best corrected visual acuity improvement (p = 0.01) could be achieved only in group 2. The combined treatment was significantly superior (p < 0.01) to treatment with only electromagnetic stimulation regarding best corrected visual acuity and deep retinal capillary density. In the control group (group 3), there was no statistically significant change (p = 0.09) in the mean deep retinal capillary density and best corrected visual acuity. CONCLUSION Treatment of the underlying cause is a priority in the treatment of deep retinal capillary ischemia. However, in the acute period, local ischemia treatment is necessary to prevent permanent retinal damage and scotomas. In mild cases, only electromagnetic stimulation, which is non-invasive and easy to use, might have a beneficial effect on deep retinal capillary density. In more severe cases, sub-tenon fresh autologous platelet-rich plasma injection together with electromagnetic stimulation may be more effective in the treatment of local ischemia of the retina in order to augment the response. FUNDING The Rapid Service Fees were funded by the Ankara University Tecnopolis Institute. CLINICAL TRIAL REGISTRATION titck.gov.tr identifier, 2018-136.
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Affiliation(s)
- Emin Özmert
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Umut Arslan
- Ankara University Technopolis, Ankara, Turkey.
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Deschamps R, Vasseur V, Shor N, Vignal C, Salomon L, Gout O, Mauget‐Faÿsse M. A new association: acute macular neuroretinopathy in acute optic neuritis. Acta Ophthalmol 2019; 97:e753-e756. [PMID: 30761755 PMCID: PMC6798266 DOI: 10.1111/aos.14054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/19/2019] [Indexed: 02/06/2023]
Abstract
Background Acute optic neuritis (AON) is a common optic nerve disease leading to retrograde degeneration of optic nerve axons, reflected by thinning of the inner retinal layers on optical coherence tomography. On the contrary, acute macular neuroretinopathy (AMN) type 2 is a rare outer retinal disorder that leads to thinning of the outer nuclear layers and is diagnosed by multimodal imaging. The aim of this study was to report a new association between these two diseases. Methods Patients with a first episode of optic neuritis were invited to participate in a study that involved optical coherence tomography evaluation at baseline and the following 1, 3, 6 and 12 months. All the study patients underwent ophthalmologic evaluation that comprised of visual acuity, visual field and multimodal imaging as well as orbital and brain Magnetic Resonance Imaging. A diagnosis of multiple sclerosis was made according to the 2010 McDonald criteria. Results Six of the 114 patients with acute optic neuritis also had acute macular neuroretinopathy, of whom three were positive for myelin oligodendrocyte glycoprotein antibodies (MOG‐Abs), two had relapsing–remitting multiple sclerosis and one had clinical isolated syndrome. Conclusion Our study suggests that it is imperative to check for associated AMN in cases of AON, especially those associated with MOG‐Abs.
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Affiliation(s)
- Romain Deschamps
- Department of Neurology Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Vivien Vasseur
- Clinical Research Department Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Natalia Shor
- Department of Radiology Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Catherine Vignal
- Department of Neuro‐Ophthalmolology Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Laurence Salomon
- Clinical Research Department Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Olivier Gout
- Department of Neurology Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Martine Mauget‐Faÿsse
- Clinical Research Department Fondation Ophtalmologique Adolphe de Rothschild Paris France
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Casalino G, Sivagnanavel V, Pavesio C. Sudden Fixed Swirl Circles in the Vision of a Young Healthy Woman. JAMA Ophthalmol 2019; 137:457-458. [PMID: 30730536 DOI: 10.1001/jamaophthalmol.2018.5919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Giuseppe Casalino
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Vasuki Sivagnanavel
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, United Kingdom
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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40
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Chen YC, Chen SN. Microvascular change in acute macular neuroretinopathy by using optical coherence tomography angiography. Taiwan J Ophthalmol 2019; 9:118-121. [PMID: 31198671 PMCID: PMC6557066 DOI: 10.4103/tjo.tjo_83_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 27-year-old pregnant female underwent cesarean section due to preeclampsia. Two days after the delivery, she presented with acute onset of blurred vision in the left eye. Optical coherence tomography (OCT) revealed characteristic findings of acute macular neuroretinopathy (AMN) in both eyes. During the follow-up, her vision improved gradually, but outer nuclear layer thinning with disruption of ellipsoid zone was identified from OCT. OCT angiography was arranged and revealed both vascular defect in superficial and deep vascular plexus, which correlated with previous AMN lesions in both eyes. Subsequent microvascular change in AMN was found to involve both superficial and deep vascular plexus, which is different from the current consensus that AMN mainly involved deep vascular plexus. By using the OCT angiography, we can better visualize the detail retinal vascular structure and may identify the real mechanism in this rare retinal disorder.
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Affiliation(s)
- Yen-Chih Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Medicine, School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
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Agarwal A, Aggarwal K, Gupta V. Infectious uveitis: an Asian perspective. Eye (Lond) 2019; 33:50-65. [PMID: 30315262 PMCID: PMC6328604 DOI: 10.1038/s41433-018-0224-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023] Open
Abstract
Several intraocular infections can present with protean manifestations posing major diagnostic and management challenges. Infections such as tuberculosis, dengue and chikungunya fever have continued to remain major endemic diseases that are associated with uveitis in the Asia Pacific region. These entities often require a high index of clinical suspicion and laboratory analysis including assays of ocular fluids and/or tissues for confirmation of the diagnosis. Infectious uveitis caused by tuberculosis, dengue and chikungunya can present with characteristic clinical features and imaging findings on ancillary investigations; that may provide clue to the early diagnosis. Use of modern imaging modalities such as enhanced-depth imaging optical coherence tomography, optical coherence tomography angiography and ultra-wide field fundus photography greatly aid in the evaluation of these conditions. In the current review, we have discussed the epidemiology, clinical phenotypes, imaging characteristics, diagnosis and management of uveitis caused by tuberculosis, dengue and chikungunya.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Bottin C, Grieve K, Rossant F, Pedinielli A, Mrejen S, Paques M. DIRECTIONAL VARIABILITY OF FUNDUS REFLECTANCE IN ACUTE MACULAR NEURORETINOPATHY: EVIDENCE FOR A CONTRIBUTION OF THE STILES-CRAWFORD EFFECT. Retin Cases Brief Rep 2018; 12 Suppl 1:S19-S24. [PMID: 29369084 DOI: 10.1097/icb.0000000000000701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To document directional reflectivity of fundus lesions in a case of acute macular neuroretinopathy. METHODS Case report. Clinical and imaging data from a patient with acute macular neuroretinopathy were reviewed. Imaging comprised infrared scanning laser ophthalmoscopy, optical coherence tomography and flood-illumination adaptive optics images acquired through different entry pupils in the cardinal directions (approximately 2° eccentricity). RESULTS The patient reported acute bilateral paracentral scotoma revealing dark, wedge-shaped macular plaques which by optical coherence tomography were associated with focal loss of the visibility of the cone outer segment tip and inner/outer segment lines. Comparing scanning laser ophthalmoscopy images taken at different entry points in the pupil showed that macular plaques varied from hyporeflectance to isoreflectance. Cone counts by flood-illumination adaptive optics within plaques and optical coherence tomography features of the cone outer segment tip showed also a strong directional variability, peaking at near-normal values. Within each modality, fusion images showed that directional variability covered most of macular plaques. CONCLUSION The characteristic fundus abnormalities of acute macular neuroretinopathy may show a strong directional variability. Our findings suggest that the Stiles-Crawford effect may be an important factor in signs and symptoms of acute macular neuroretinopathy.
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Affiliation(s)
- Caroline Bottin
- Ophthalmology Department, Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS Clinical Investigation Center 1423, Paris, France
| | - Kate Grieve
- Ophthalmology Department, Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS Clinical Investigation Center 1423, Paris, France
- Université Pierre et Marie Curie-Paris 6, Paris, France
| | | | | | - Sarah Mrejen
- Ophthalmology Department, Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS Clinical Investigation Center 1423, Paris, France
| | - Michel Paques
- Ophthalmology Department, Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS Clinical Investigation Center 1423, Paris, France
- Université Pierre et Marie Curie-Paris 6, Paris, France
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Agarwal A, Aggarwal K, Dogra M, Kumar A, Akella M, Katoch D, Bansal R, Singh R, Gupta V. Dengue-Induced Inflammatory, Ischemic Foveolitis and Outer Maculopathy: A Swept-Source Imaging Evaluation. Ophthalmol Retina 2018; 3:170-177. [PMID: 31014768 DOI: 10.1016/j.oret.2018.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Dengue maculopathy can present with a unique constellation of features resulting in significant central visual morbidity. We aim to describe various findings of dengue-induced inflammatory, ischemic foveolitis, and outer maculopathy (DIII-FOM) and assess the serial changes in vitreous inflammation, retinal structure, and vascularity using swept-source OCT (SS-OCT) and OCT angiography (OCTA). DESIGN Retrospective case series. PARTICIPANTS A total of 32 eyes (16 patients; 7 male) with dengue fever (positive serology for NS1 antigen) were enrolled in the study. METHODS In this study, serial assessments of ocular findings and imaging using fundus photography, SS-OCT, and SS-OCTA were performed. All the patients received 0.5 to 1 mg/kg/day oral prednisolone that was tapered over 4 to 6 weeks. MAIN OUTCOME MEASURES Outcome measures included functional change, that is, improvement in best-corrected visual acuity (BCVA), structural changes in the vitreous and retinal layers on SS-OCT, and retinal perfusion on OCTA. RESULTS The mean age of the patients was 29.17±10.91 years. Swept-source OCT showed vitreous cells (32 eyes; 100%), disruption of outer retinal layers (foveolitis) (24 eyes; 75%), and conical foveal elevation (22 eyes; 68.75%). After initiation of systemic corticosteroids, all the eyes showed resolution of vitreous cells and improvement in the integrity of retinal layers. Mean BCVA improved from an initial 0.80±0.33 logarithm of the minimum angle of resolution (logMAR) to 0.23±0.36 logMAR. Retinal plexus flow deficit (superficial plexus: 0.10±0.12 mm2; deep plexus: 0.29±0.13 mm2) persisted in all eyes and correlated well with initial BCVA (P < 0.05). CONCLUSIONS The pathophysiology of dengue maculopathy involves both ischemic and inflammatory components. Early institution of corticosteroid therapy may help in resolution of the inflammation-driven vitreoretinal alterations, but ischemia of the deep retinal plexuses may persist and may be the cause of permanent structural and functional changes.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Aman Kumar
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Madhuri Akella
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Reema Bansal
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
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Casalino G, Arrigo A, Romano F, Munk MR, Bandello F, Parodi MB. Acute macular neuroretinopathy: pathogenetic insights from optical coherence tomography angiography. Br J Ophthalmol 2018; 103:410-414. [DOI: 10.1136/bjophthalmol-2018-312197] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/04/2018] [Indexed: 11/04/2022]
Abstract
AimTo describe the optical coherence tomography angiography (OCT-A) features of patients affected by acute macular neuroretinopathy (AMN).Methods This is a prospective, observational, cross-sectional study. Multimodal imaging, including spectral domain OCT (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) and 6×6 mm swept source OCT-A (ZEISS PLEX Elite 9000; ZEISS, Dublin, California), was performed on all patients. The primary outcome measure was assessment of the vascular alterations of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC). A segmentation of the AMN lesions using enface OCT images of photoreceptors-retinal pigment epithelium complex was used to discriminate intralesional and extralesional regions on the OCT-A enface slabs of the DCP and CC reconstructions. Each OCT-A slab was imported into ImageJ V.1.50 and digitally binarised for quantitative analyses.ResultsOverall, seven patients (mean age 19.4±3.2 years, six women) affected by AMN were included. The mean best-corrected visual acuity was 0.00±0.00 logarithm of the minimum angle of resolution. Twelve healthy age-matched subjects (mean age 22±3.4 years, 10 women) represented the control group. The quantitative analysis of global vessel densities showed that the CC vessel density was significantly lower in patients with AMN (0.495±0.03) compared with the age-matched controls (0.545±0.02) (corrected p=0.0003). The intralesional vessel density of the DCP was 0.349±0.04 in AMN and vs 0.497±0.02 in the controls (corrected p=0.0002).ConclusionsOur study confirmed inner choroidal vascular flow void as a possible pathogenetic mechanism of AMN. We also found a focal impairment of the DCP within the AMN lesions. Future studies are needed to clarify which is the primary location of the vascular insult in this condition.
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Serafini S, Lohmann CP, Ulbig M. [A young patient with full visual acuity, small visual field defects, and normal fluorescence angiogram]. Ophthalmologe 2018; 116:176-180. [PMID: 29797073 DOI: 10.1007/s00347-018-0733-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A 28-year-old female patient came to our clinic complaining of small central visual field defects in both eyes, without any impairments of visual acuity. She reported recent flu-like symptoms and work-related stress associated with high caffeine intake. Dark reddish cloverleaf-shaped lesions were noted in the macular region with red-free fundoscopy, and alterations of the external retinal layers were observed in spectral domain optical coherence tomography (SD-OCT). The visual field test (Octopus, program 32) revealed small central scotoma on both eyes. The fluorescein angiograms were normal. A suspected diagnosis of acute macular neuroretinopathy (AMNR) was made and the patient was scheduled for follow-up 4 weeks later. The follow-up examination showed persisting central scotoma as well as persistence of the lesions in the external retinal layers in OCT. The best-corrected visual acuity was still 20/20. In OCT angiography (OCT-A), a reduced correlation signal and therefore perfusion was detected in the outer retinal capillary plexus within the area of the fundoscopic macular lesions. Multimodal imaging, including SD-OCT and A‑OCT, plays a pivotal role in the diagnosis of acute macular neuroretinopathy. Even though no serious impairments of visual acuity are reported, patients should be informed about the possibility of permanent central scotoma.
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Affiliation(s)
- S Serafini
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - C P Lohmann
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Ulbig
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Yang YS, Zhang L, Asdaghi N, Henry CR, Davis JL. ACUTE MACULAR NEURORETINOPATHY IN SUSAC SYNDROME: A NEW ASSOCIATION. Retin Cases Brief Rep 2018; 14:310-314. [PMID: 29596114 DOI: 10.1097/icb.0000000000000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of acute macular neuroretinopathy in a patient with Susac syndrome. METHODS Case report. RESULTS A 39-year-old male patient presented with severe headache, photopsias, and a sudden onset of hearing loss in the right ear. Fluorescein angiography of the right eye revealed multiple branch retinal artery occlusions. Clinical presentation of encephalopathy, hearing loss, and branch retinal artery occlusions, along with characteristic magnetic resonance imaging findings, led to a diagnosis of Susac syndrome. Despite aggressive immunosuppression for four months, the patient later presented with acute macular neuroretinopathy in the left eye. CONCLUSION Acute macular neuroretinopathy and Susac is a new association of two well-defined disorders. The concurrence of both disorders supports retinal ischemia as the proximate cause of acute macular neuroretinopathy and inflammation as a potential etiology.
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Affiliation(s)
- Yong-Sheng Yang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Liu JC, Nesper PL, Fawzi AA, Gill MK. Acute macular neuroretinopathy associated with influenza vaccination with decreased flow at the deep capillary plexus on OCT angiography. Am J Ophthalmol Case Rep 2018. [PMID: 29541690 PMCID: PMC5849782 DOI: 10.1016/j.ajoc.2018.02.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose We report a case of acute macular neuroretinopathy (AMN) following routine annual inactivated influenza vaccination. Projection-resolved optical coherence tomography angiography (PR-OCTA) was used to analyze the retinal capillary flow within the AMN lesion. Observations Our patient reported visual symptoms of her right eye nine days after routine annual influenza vaccination. Multimodal imaging revealed small vessel peripheral vasculitis and AMN in the affected eye. Infectious, immunologic, and hypercoagulable etiologies were investigated and excluded. PR-OCTA B-scans within the AMN lesion demonstrated reduced flow in the deep capillary plexus (DCP) at baseline with relatively improved flow signal in the DCP on follow up, 3 weeks later. Conclusions and importance We report a new association of AMN following routine inactivated influenza immunization. Recent influenza vaccination should be included in the differential diagnosis for patients presenting with AMN. PR-OCTA demonstrated compromised DCP flow in the AMN lesion which has not been previously described.
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Affiliation(s)
| | | | | | - Manjot K. Gill
- Corresponding author. 645 North Michigan Avenue, Suite 440, Chicago, IL 60611, United States.
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Aggarwal K, Agarwal A, Katoch D, Sharma M, Gupta V. Optical coherence tomography angiography features of acute macular neuroretinopathy in dengue fever. Indian J Ophthalmol 2017; 65:1235-1238. [PMID: 29133664 PMCID: PMC5700606 DOI: 10.4103/ijo.ijo_485_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 39-year-old female with dengue fever presented with decreased vision in both eyes. Visual acuity was 20/200 and 20/80 in the right eye (OD) and left eye (OS), respectively. Fundus showed granular, grayish-white lesions in the parafoveal region in OD. Multimodal imaging including optical coherence tomography angiography (OCTA), optical coherence tomography (OCT), and fluorescein angiography (FA) was performed. FA showed late hyperfluorescence with few microaneurysms in OS. OCT showed hyperreflectivity in various layers, suggestive of acute macular neuroretinopathy (AMN). OCTA showed disruption of retinal capillary plexuses. This case shows how OCTA provides newer insights into the pathogenesis of AMN lesions in dengue fever.
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Affiliation(s)
- Kanika Aggarwal
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Sharma
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Akanda M, Gangaputra S, Kodati S, Melamud A, Sen HN. Multimodal Imaging in Dengue-Fever-Associated Maculopathy. Ocul Immunol Inflamm 2017; 26:671-676. [PMID: 28980843 DOI: 10.1080/09273948.2017.1351571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dengue fever can cause ocular complications that may not be easily identified during a regular eye examination. A high degree of suspicion and multimodal imaging will help characterize the lesions during acute stages of the infection.
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Affiliation(s)
- Marib Akanda
- a National Eye Institute , Bethesda , Maryland , USA
| | | | - Shilpa Kodati
- a National Eye Institute , Bethesda , Maryland , USA
| | | | - H Nida Sen
- a National Eye Institute , Bethesda , Maryland , USA
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Troncoso LL, Biancardi AL, de Moraes Jr HV, Zaltman C. Ophthalmic manifestations in patients with inflammatory bowel disease: A review. World J Gastroenterol 2017; 23:5836-5848. [PMID: 28932076 PMCID: PMC5583569 DOI: 10.3748/wjg.v23.i32.5836] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/29/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.
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Affiliation(s)
- Leandro Lopes Troncoso
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Ana Luiza Biancardi
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | | | - Cyrla Zaltman
- Department of Internal Medicine, Gastroenterology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
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