Acute Macular Neuroretinopathy after COVID-19 Infection: Clinical Characteristics and Associated Factors

Acute macular neuroretinopathy (AMN) is a rare, poorly understood retinal disease that affects the outer retina. Recent studies reported the onset of AMN is associated with COVID-19 infection. However, it still lacks thorough evaluation regarding the clinical features of AMN after COVID-19 infection.

Retrospective cohort study.

This study involved online registration of patients who were diagnosed with AMN after rapid antigen or PCR tests confirmed COVID-19 infections from December 2022 to March 2023.

We interviewed all patients and completed an evaluation survey that recorded age, sex, menstruation pattern, medical history, doses of COVID-19 vaccination, symptom onset (days after fever onset), symptoms, and treatment measures. The association between clinical characteristics and baseline visual acuity was investigated.

Demographic and clinical characteristics of AMN after COVID-19 infection.

A total of 116 eyes from 66 patients were included in the present study. The average age was 30.4 ± 6.7, and 81.8% of patients were female. The average time of ocular symptom onset was 2.62 ± 1.88 days after fever onset. Scotomas (87.9%) were the most common symptoms reported by patients, whereas 25.9% and 1.7% of eyes had blurry vision and photopsia. 80.2%, 60.3%, 26.7%, 10.3%, and 3.4% of eyes showed ellipsoid zone (EZ) disruption, hyper-reflectivity of outer nuclear layer (ONL), hyper-reflectivity of Henle layer, hyper-reflectivity of outer plexiform layer (OPL), and macular edema, respectively. A history of smoking (Coef. =0.12, 95%CI: [0.00, 0.24]), macular edema (Coef. =0.14, 95%CI: [0.00, 0.88]), hyper-reflectivity of OPL (Coef. =0.16, 95%CI: [0.08, 0.24]), hyper-reflectivity of Henle layer (Coef. =0.08, 95%CI: [0.03, 0.14]), and EZ disruption (Coef. =0.07, 95%CI: [0.00, 0.13]) were associated with worse LogMAR visual acuity at baseline.

AMN after COVID-19 infection is more common in young females. Hyper-reflectivity of ONL and EZ disruption are the most common OCT features of AMN. Macular edema, hyper-reflectivity of OPL, hyper-reflectivity of the Henle layer, EZ disruption, and a history of smoking are associated with worse visual acuity at baseline.