Spectral domain optical coherence tomography evolutive features in acute macular neuroretinopathy

To demonstrate the usefulness of spectral domain optical coherence tomography (SD-OCT) in investigating the evolution of the retinal outer lesions seen in acute macular neuroretinopathy (AMN).

A 32-year-old woman presented with a 1-day history of paracentral dark spot in the left eye, preceded by a flulike illness. A full ophthalmologic examination, color vision, visual field examination, and conventional imaging of the retina were done. Scanning laser ophthalmoscopic infrared imaging and SD-OCT of the macular region were performed.

Best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination as well as retinal photographs were unrevealing. Scanning laser ophthalmoscopic infrared examination showed a dark, sharp, oval area in the macular region that corresponded to a rounded patch drawn by the patient on an Amsler grid. The SD-OCT showed focal highly reflective lesion of outer plexiform layer (OPL) extending to the outer nuclear layer. After recovery of the OPL, follow-up SD-OCT showed an associated disruption of the external limiting membrane and the retinal pigment epithelium inner band as well as thinning of the inner segment/outer segment junction. Retinal inner layers were otherwise normal.

Spectral domain optical coherence tomography is of particular interest in the diagnosis of AMN. It is also very useful in featuring the chronological events happening in the outer retina. As the lesions shown are confined to the outer layers, this condition should be called acute macular outer retinopathy rather than AMN.