Optical Coherence Tomographic Angiography in Acute Macular Neuroretinopathy

Acute macular neuroretinopathy (AMN) is a rare, yet increasingly recognized, entity identified predominantly in young healthy females with acute onset of paracentral scotomas. The exact pathophysiology is unknown but an underlying vascular process is suspected. This study used optical coherence tomographic angiography (OCTA) to assess for any evidence of vascular flow abnormality in the retina or choroid in this elusive disease.

Three eyes from 2 young female patients with classic features of AMN are presented. Multimodal imaging testing, including near-infrared reflectance, spectral-domain OCT, and OCTA (Carl Zeiss Meditec), were performed. Near-infrared reflectance identified typical hyporeflective tear-drop parafoveal lesions, which corresponded to OCTA flow deficits at the level of the choriocapillaris.

Recognizing that these findings are based only on 3 eyes from 2 patients, lesions in AMN may result from a vascular insult in the choriocapillaris. The evaluation of OCTA was with the knowledge of the AMN diagnosis, which may have biased the interpretation.