J Korean Ophthalmol Soc.  2017 Jun;58(6):751-755. 10.3341/jkos.2017.58.6.751.

A Case of Acute Macular Neuroretinopathy in a Young Male

• Kim SJ
• Park YM
• Cho HK
• Huh HD
• Park JM

• KMID: 2382688
• DOI: http://doi.org/10.3341/jkos.2017.58.6.751

Abstract

PURPOSE
We report a rare case of unilateral acute macular neuroretinoapthy in a young male.
CASE SUMMARY
A 35-year-old male presented with a 2-day history of paracentral scotoma. He had suffered for 2 days from a flu-like illness, and his best corrected visual acuity was 20/20 OD and 20/20 OS. Pupillary reflex was normal and no relative afferent pupillary defects were not found. Ocular movement test was normal and pain on ocular movement was not noticed. Ophthalmoscopic examination of the left eye revealed multiple exudates lining the nasal macula toward the fovea. A Humphrey visual field study identified small paracentral scotoma. Spectral domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Heidelberg, Germany) of the lesions showed a hyper-reflective lesion located in the outer plexiform layer and inflammatory cell infiltration. Fluorescent angiography was normal in the macula but showed late leak at the disc. The multifocal electroretinogram (mfERG) showed decreased foveal P1 amplitude in the left eye. The patient was diagnosed with acute macular neuroretinopathy and was treated with 60 mg of prednisolone. His subjective symptoms were improved, the paracentral scotoma disappeared, and the lesions appeared different upon SD-OCT; specifically, the hyper-reflective lesion disappeared and the outer plexiform layer showed thinning.
CONCLUSIONS
Acute macular neuroretinopathy is a rare disease, and we report a case using SD-OCT and mfERG.

Keyword

Acute macular neuroretinopathy; Multifocal electroretinogram (mfERG); Spectral domain optical coherence tomography (SD-OCT)

MeSH Terms

Adult
Angiography
Exudates and Transudates
Humans
Male*
Prednisolone
Pupil Disorders
Rare Diseases
Reflex, Pupillary
Scotoma
Tomography, Optical Coherence
Visual Acuity
Visual Fields
Prednisolone

Figure

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  Figure 1 Baseline examination findings at the initial presentation. (A) Baseline color ophthalmoscopic image revealed a paracentral striae nasal to fovea in the left eye. (B) Near-infrared imaging revealed a subtle, dark-gray lesion at the infero-nasal to the fovea. (C) Fluorescein angiography (FA) at 30 seconds, and (D) FA at 13 minutes denoted fluorescein leakage at disc in late phase. (E) Spectral domain optical coherence tomography revealed a hyperreflective band that involved outer nucler layer and inflammatory cells were infiltrated in the outer plexiform layer (arrows). (F) Multifocal electroretinogram showed decreased P1 amplitude with corresponding lesion of nasal to the fovea (circle).

• 

  Figure 2 Humphery visual field test. (A, B) Paracentral scotoma was found at initial visit. (C, D) Paracentral scotoma was improved on visual field test 2 months after initial presentation.

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  Figure 3 Spectral domain optical coherence tomography scans. Serial spectral domain optical coherence tomography scans displayed gradual resolution of the hyperreflectivity with persistence of punctate hyperreflective areas within the outer plexiform layer (OPL) and outer nuclear layer (arrows), as well as progressive atrophy of the involved OPL (arrowheads). The thickness of the involved OPL was 42-73 µm at baseline optical coherence tomography scan, 26-36 µm at 2 weeks, 31-47 µm at 4 weeks and 23–32 µm at 8 weeks (A: 2 weeks after presentation; B: 4 weeks after presentation; C: 8 weeeks after presentation).

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