Acute macular neuroretinopathy in COVID-19 patients: Short-term prospective follow-up observation

This study aims to characterize the multimodal imaging findings and clinical features of acute macular neuroretinopathy (AMN) in a series of coronavirus disease 2019 (COVID-19) patients from China.

In this observational study, a total of 18 patients (30 eyes) with post-COVID-19 infection presenting as AMN were enrolled between December 2022 and May 2024 and underwent a minimum of 12 months of ophthalmic follow-up. Multimodal imaging features following severe acute respiratory syndrome coronavirus 2 infection were evaluated by infrared (IR) reflectance imaging, ultrawide-field scanning laser ophthalmoscopy, spectral-domain optical coherence tomography (SD-OCT), optical coherence tomography angiography, visual field testing, and fundus fluorescein angiography.

Scotomas were present in all 18 patients (30 eyes) at the initial visit. IR reflectance imaging revealed localized areas of hyporeflectivity in the macular region in 5 patients (8 eyes). SD-OCT scans demonstrated hyper-reflective changes within the photoreceptor layer and disruption of its normal laminar architecture in all 18 patients (30 eyes). All cases in this series exhibited signs of classic maculopathy. Notably, these abnormalities persisted for at least 12 months in all affected eyes.

These data suggest that AMN is a significant ocular manifestation in patients with COVID-19, characterized by persistent scotomas lasting at least 12 months.