Acute Macular Neuroretinopathy following Oral Intake of Adrenergic Flu Treatments

Pharmacology of chlorphenamine and pseudoephedrine use in the common cold: a narrative review

The common cold is the most frequent upper respiratory viral infection. Although benign, it represents a high socioeconomic burden. Many over-the-counter drugs are available to manage the symptoms of this condition, with antihistamines and vasoconstrictors being the most widely used. This review aimed to compare the potential mechanisms underlying the efficacy and safety of chlorphenamine and pseudoephedrine, the most commonly used agents in these two classes of drugs, and provide a useful perspective to impact appropriate decisions when considering these options for symptomatic common cold treatment. To conduct a comprehensive analysis, we systematically reviewed the use of pseudoephedrine and chlorphenamine using various databases, including MEDLINE, Google Scholar, Scopus, and Embase. We also perused the bibliographies of relevant articles and the EudraVigilance database. The findings suggest that pseudoephedrine may offer specific benefits in rapidly alleviating nasal congestion in the short term. Chlorphenamine appears to exhibit a higher degree of efficacy in alleviating rhinorrhea and other specific cold symptoms compared to pseudoephedrine. Pharmacovigilance data and case report reviews showed that pseudoephedrine may induce a higher incidence of less common but potentially life-threatening adverse effects compared to chlorphenamine. We concluded that antihistamine drugs exhibit a more favorable benefit/risk profile than vasoconstrictors for treating symptomatic common colds.

PARACENTRAL ACUTE MIDDLE MACULOPATHY FOLLOWING ORAL INTAKE OF SUMATRIPTAN

PURPOSE

The purpose of this report was to describe a case with paracentral acute middle maculopathy after oral intake of sumatriptan.

METHODS

Case presentation.

RESULTS

One patient showed typical findings on fundoscopic examination and optical coherence tomography consistent with paracentral acute middle maculopathy following oral intake of sumatriptan.

CONCLUSION

Sumatriptan may be a trigger for paracentral acute middle maculopathy.

Acute macular neuroretinopathy in dengue virus serotype 1

Purpose

To report a case of acute macular neuroretinopathy (AMN) associated with dengue virus serotype 1 infection.

Observation

An 18-year-old Puerto Rican female was evaluated due to painless paracentral scotomas in each eye that developed after being hospitalized for dengue fever a week before. Clinical examination and multimodal imaging revealed bilateral hypopigmented macular lesions, hyperreflectivity at the outer nuclear and photoreceptor layer, and reduced flow signal in the deep capillary plexus. Additionally, hypoautofluorescent parafoveal lesions were found in the left eye. AMN was diagnosed. Two-month follow-up after the initial evaluation showed resolution of symptoms but persistence of some findings on optical coherence tomography.

Conclusions and importance

Patients with dengue virus serotype 1 may develop paracentral scotomas with classic AMN findings and obtain complete symptomatic recovery without treatment.

Acute Macular Neuroretinopathy in a Patient with Retinal Vascular Tortuosity

We report a rare case of a young woman with acute macular neuroretinopathy (AMN) in the right eye and concomitant retinal vascular tortuosity in both eyes. A 19-years-old woman presented with a sudden loss of central vision in the right eye. Apart from flu-like infection 2 weeks before the onset of symptoms, she reported overall good health. She used oral contraceptive pills. Multimodal imaging techniques including color fundus photography, fundus autofluorescence, infrared reflectance imaging, fluorescein angiography, swept-source optical coherence tomography (SS-OCT), and visual field assessment were used for the diagnosis of AMN as well as disease monitoring during follow-up. At presentation, ophthalmoscopy revealed a reddish parafoveal lesion, while SS-OCT showed hyper-reflectivity in the outer plexiform and outer nuclear layers with a slightly disrupted inner segment/outer segment junction. All these imaging findings indicated AMN, but the interpretation was slightly difficult due to the presence of tortuous retinal arteries in both eyes. During the disease course, functional and morphological recovery was documented at 1- and 6-month follow-up. However, as the abnormal appearance of the retinal vessels did not change, congenital retinal vascular tortuosity was diagnosed. Since the pathogenesis of AMN has not been fully elucidated, there is currently no effective treatment. Numerous studies have emphasized a vascular origin and the key role of ischemia in AMN. Our rare case suggests that congenital tortuosity of the retinal vessels, although constituting a common finding in healthy individuals, may be involved in the pathophysiology of the disease.

Acute macular neuroretinopathy (AMN) related to energy drink consumption

This case identifies a newly found association between energy drinks and acute macular neuroretinopathy (AMN). Our patient, a 34-year-old woman with no significant ocular or previous medical history, presented with a 3-day history of decreased vision after consumption of multiple energy drinks. After near infrared and optical coherence tomography imaging, we were able to diagnose her with AMN. Our patient's vision improved over a 2-month course with no intervention. Our case aims to emphasise the effect of caffeine on the retina, as well as encourage clinicians to consider energy drinks as a causative agent of AMN.

Acute Macular Neuroretinopathy Associated with Acute Influenza Virus Infection

Purpose: To describe a prospective case series of patients with acute macular neuroretinopathy (AMN) associated with acute influenza virus infectionMethods: Patients who presented with acute macular neuroretinopathy associated with confirmed influenza virus infection were subject to a detailed clinical history, HLA typing and longitudinal ophthalmological and imaging examinations.Results: Four female patients aged 18 to 32 years were studied. They reported the onset of ocular symptoms between 2 and 5 days after the development of flu like symptoms. Three patients had confirmed acute influenza B infection, while the fourth had influenza A. OCT angiography only demonstrated abnormal choriocapillaris perfusion in 1 patient and early oral Oseltamivir treatment appeared not to affect the ophthalmic outcome in one patient.Conclusion: This is the first report of AMN associated with virologically confirmed acute influenza virus infection. Variation in HLA alleles do not appear to predispose patients to influenza associated AMN.