Fundus features of acute macular neuroretinopathy after SARSCoV2 infection: A multimodal imaging analysis

Acute macular neuroretinopathy (AMN) is a rare macular disease. We aimed to report the fundus multimodal imaging features of AMN with SARSCoV2 infection. Six consecutive cases of AMN occurred in our hospital from December 2022 to January 2023, all within one week after COVID-19 infection. 6 patients (12 eyes) diagnosed as AMN with SARSCoV2 infection were selected. All 6 patients developed high fever post-SARS-CoV-2 infection, with sudden central/paracentral scotoma appearing 2-4 days later as the main visual symptom. Fundus examination showed normal fundus in 4 eyes and macular foveal reflection loss in 8 eyes. The infrared reflectance imaging demonstrated localized areas of hyporeflection in or around the macula, among them, 7 eyes had hyporeflection lesions located in fovea of macula, and 5 eyes were located on the nasal side of fovea of macula. The fluorescein fundus angiography (FFA) revealed no vascular pathology. In all eyes, optical coherence tomography (OCT) shows hyperreflective in the photoreceptor layers, the external limiting membrane, outer nuclear layer up to the outer plexiform layer, and defect involving the ellipsoid and interdigitation zone. Optical coherence tomography angiography (OCTA) shows deep capillary plexus (DCP) vascular texture was diffusely sparse in 1 eye; enface imaging shows high reflection in the corresponding area. No difference was observed in imaging features between AMN after SARS-CoV-2 infection and AMN not related to SARS-CoV-2. However, the increasing cases after COVID-19 infection imply that patients with SARS-CoV-2 infection are at greater risk of developing AMN.