Acute macular neuroretinopathy

Abstract

An unrecognized acute macular affection occurred in four women, 24 to 35 years old, using oral contraceptives who complained of a sudden decrease of visual acuity or paracentral scotomas. Three patients had bilateral lesions and one patient had unilateral lesions. These lesions consisted of darkish brown-red, wedge-shaped dots in the macula pointing to the fovea. These dots were located mostly on the nasal side to the macula. Biomicroscoby showed these lesions were located in the superficial layers of the retina. The retinal vessels, pigment epithelium, and optic disk showed no distinct pathologic features. Fluorescein angiography, performed repeatedly, showed some questionably dilated perimacular capillaries without leakage in two cases. Static perimetry delineated dense paracentral scotomas. Recovery was slow or absent, confirmed py perimetric observation. Ophthalmoscopic, fluorescein angiography, and perimetric details excluded an affection of the pigment epithelium, the nerve fiber layer, and the optic disk. Since the affection appears to be localized superficially in the retina, we called this specific entity acute macular neuroretinopathy.

PIP: 4 cases of women suffering from acute macular neuroretinopathy (neuroepitheliopathy) were described. The disease was so named by the authors because of the acute onset and localization of lesions in the more superficial retinal layers of the macula, and because there was no similar disease process known to them. The women (aged 24-33 years) had been taking oral contraceptives for years. Routine opthalmoscopic examination; fundus photography, and fluorescein-angiography were done in all patients. The women had a peculiar acute macular affection characterized by slight depression of visual acuity and paracentral scotomas corresponding with dark reddish, wedge-shaped intraretinal lesions pointing to the fovea. 3 patients had bilateral lesions and 1 had unilateral lesions. Biomocroscopy revealed the location of the lesions to be in the superficial layers of the retina. Questionable dilated perimacular capillaries without leakage were seen through repeated fluorescein-angiography in 2 cases. Both macular pigment epithelium and retinal vessels appeared normal, as did the optic disk and nerve fiber. Visual recovery, when present, was slow.