PMC8138200_01
a, b Colour fundal photo and infrared reflectance images of the left posterior poles at presentation demonstrating a hyporeflective wedge-shaped lesion at the left macula with linear hyperreflective bands superiorly and nasally. Infrared reflectance image of the left posterior poles at day 4, demonstrating a hyporeflective wedge-shaped lesion at the left macula (c). Multicolour image of left posterior pole at day 45 (d).
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F1
Left fundus photography and infrared reflectance demonstrated subtle linear brown lesions in a pseudo-macular star appearance (Fig. 1). Infrared reflectance imaging showed classic wedge-shaped lesions extending outwards from the fovea (Fig. 1c).
a, b Automated perimetry of the right and left eyes demonstrating a left central scotoma. c Amsler grid drawn by the patient to demonstrate scotoma from left eye.
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F2
Computerized perimetry demonstrated a paracentral scotoma (Fig. 2), with a corresponding Amsler grid illustration by the patient (Fig. 2c).
a Ocular coherence tomography of the left macula during the acute phase, demonstrating a hyperreflective band extending outwards from the outer plexiform layer consistent with an AMN lesion. b Left macula at day 4. Note the disruption of the outer retinal layers in the area corresponding to the acute macular neuroretinopathy lesion. c Left macula at day 45. Note the loss of outer retinal layers. AMN, acute macular neuroretinopathy.
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F3
Spectral-domain ocular coherence tomography (SD-OCT) (Spectralis; Heidelberg Engineering, Heidelberg, Germany) initially revealed a small cuff of subfoveal fluid and band-like hyperreflectivity extending outwards from the outer plexiform layer consistent with AMN (Fig. 3a). It showed resolution of the subfoveal fluid and disruption of the outer retinal layers (Fig. 3b). Repeat SD-OCT revealed marked outer retinal thinning in the affected area, with disruption of the inner segment/outer segment zone (Fig. 3c).
a, b Optical coherence tomography angiography of the deep capillary plexus of the right and left fovea at day 45. There is coarsening of the deep capillary plexus in the area corresponding to the AMN lesion. c, d Optical coherence tomography angiography of the choriocapillaris of the right and left fovea at day 45. There are marked changes of the choriocapillaris underlying the lesion. AMN, acute macular neuroretinopathy.
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F4
OCT angiography (Spectralis), now available at this follow-up, demonstrated preservation of the superficial and intermediate vascular plexi but coarsening and microvascular changes in both the deep vascular plexus and the choriocapillaris (Fig. 4).