Acute macular neuroretinopathy following COVID- 19 infection

ABSTRACT

Purpose: We aim to highlight a case of COVID-19 associated acute macular neuroretinopathy (AMN), an outer retinopathy known to occur following febrile and flu-like illnesses. Method(s) Case report. Result(s) A 23-year-old Caucasian female presented with a 10-day history of sudden onset bilateral paracentral scotomata which developed following confirmed SARSCoV- 2 infection. The patient's medical history was significant for polycystic ovary syndrome and use of the combined oral contraceptive pill (OCP). Fundoscopic examination revealed multiple reddish-brown, wedge shaped lesions in both eyes perifoveally. Optical coherence tomography of these lesions demonstrated areas of ellipsoid zone disruption associated with overlying hyperreflectivity of outer retinal layers. The lesions were hyporeflective on infrared imaging. The location of lesions at the macula correlated nearly identically with Amsler grid recordings as illustrated by the patient. As a result, the patient was diagnosed with AMN. Other inflammatory, infective and hypercoaguable causes of outer retinopathy were excluded. While OCP use is a risk factor for AMN, the aetiology was determined to be associated with COVID-19, given the onset of visual symptoms closely following the onset of acute febrile illness. Conclusion(s) We report a rare case of AMN occurring in the context of recently diagnosed COVID-19, on the background of OCP use. More broadly, this case report aims to contribute to the broader literature regarding COVID- 19 associated ocular sequelae. Clinicians should consider asking about recent COVID-19 infection when encountering patients presenting with symptoms of AMN.