Low Visual Acuity Due to Acute Macular Neuroretinopathy Associated with COVID-19: A Case Report.

BACKGROUND Retinal sequelae have been reported in patients who have had COVID-19. This is a case report of acute macular neuroretinopathy (AMN), presenting with low visual acuity in the left eye, 14 days after the first symptoms of COVID-19 infection. CASE REPORT A 71-year-old woman presented for ophthalmological evaluation complaining of low visual acuity in the left eye, 14 days after the first symptoms of COVID-19 infection. COVID-19 was confirmed by a reverse-transcription polymerase chain reaction (RT-PCR) test. The left eye examination showed visual acuity of 0.5 logMAR, fundoscopy showed foveal pigment mobilization, fluorescein angiography revealed a hypofluorescent fovea surrounded by irregular hyperfluorescent defects, and spectral-domain optical coherence tomography showed central foveal thinning with disrupted interdigitation and ellipsoid zones. Given the clinical and imaging findings, the diagnosis of AMN was finalized. AMN usually resolves without specific treatment. CONCLUSIONS This case report shows that patients with COVID-19 can develop retinal involvement. AMN can be due to a viral infection, including COVID-19, and usually resolves without specific treatment. In the present case, there was no improvement in the patient's clinical condition in a 2-month follow-up to date.

Influenza-Induced Acute Macular Neuroretinopathy With Cerebral Involvement in a Ten-Year-Old Boy.

A 10-year-old male presented with 1-week duration of painless bilateral central vision loss after having been diagnosed with influenza A. Optical coherence tomography revealed superficial retinal nerve fiber layer infarcts, hyperreflectivity of the inner nuclear layer consistent with paracentral acute middle maculopathy (PAMM), and outer nuclear layer hyperreflectivity and disruption of the ellipsoid zone suggesting acute macular neuroretinopathy (AMN). Brain MRI revealed enhancement of the right basal ganglia consistent with focal encephalitis. He was diagnosed with presumed influenza-induced leukocytoclastic vasculitis (LCV) and treated with intravenous steroids. Influenza-induced LCV is a rare phenomenon and can present with AMN, PAMM, and encephalitis. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:293-297.].

A CARE-compliant article: a case report of possible association between recurrence of multiple evanescent white dot syndrome and the Herpesviridae family.

RATIONALE: Multiple evanescent white dot syndrome (MEWDS) is a self-limited multifocal chorioretinopathy that typically affects otherwise healthy young females in the second to fourth decades of life. Current understanding of the pathophysiology of MEWDS is still limited. One of the possible underlying causes is an infectious etiology. PATIENT CONCERNS: A 24-year-old female with recurrent episodes of typical MEWDS ocular manifestation was observed over 2 years. Viral-specific antibody serologic tests showed evidence of exposure to the Herpesviridae family during the acute stage of MEWDS in the first and recurrent episodes. DIAGNOSES: MEWDS was diagnosed by the clinical findings and ancillary testing results of fundus photography, optical coherence tomography, fluorescein angiography, indocyanine green angiography and electroretinogram. The laboratory serology data was positive for varicella-zoster virus (VZV) immunoglobulin M (IgM) in the first episode and exhibited high Epstein-Barr virus (EBV) elevated immunoglobulin G (IgG) titer in the recurrent episode. INTERVENTIONS: Due to the self-limited nature of MEWDS, we observed the clinical course without intervention. OUTCOMES: During acute onset of MEWDS, serologic data for VZV IgM antibody was positive in the first episode. Two years later, the patient had recurrent episodes of MEWDS in the contralateral eye. Serologic study showed highly elevated IgG titer (1:160) of Epstein-Barr virus capsid antigen (EB-VCA) in the acute stage. The follow-up paired serum virus serology test showed that the prior EB-VCA IgG titer decreased fourfold to 1:40 in the recovery stage. LESSONS: Recurrence of MEWDS may be associated with acute systemic infection of the Herpesviridae family or virus-induced autoimmune inflammatory reaction.

Multimodal Imaging of Post-Infectious Unilateral Outer Retinopathy and Choroiditis.

Purpose: To describe with multimodal imaging a case of post-infectious unilateral outer retinopathy with choroiditis. Methods: Retrospective chart review of a case of a 67-year old male who presented following the onset of viral symptoms with an acute onset outer retinopathy, small vessel leakage on fluorescein angiography, and choroidal involvement evident on indocyanine green angiography and near infrared fundus autofluorescence (NIR-AF). Work up for infectious and autoimmune etiologies was negative. Results: Treatment with IV methylprednisolone followed by high dose oral prednisone resulted in improvement in visual acuity, outer retinal reconstitution and resolution of the choroidal changes. Conclusions: Despite this presentation sharing features with both acute zonal occult outer retinopathy (AZOOR) and multifocal choroiditis (MFC), the case is highly atypical of both entities.