A Sudden Rise of Patients with Acute Macular Neuroretinopathy during the COVID-19 Pandemic

Abstract

The aim of this paper is to inform on the surge of cases of acute macular neuroretinopathy (AMN) - a rare disease characterized by the sudden onset of acute scotomas caused by ischemia of the retinal capillary plexus - during the COVID-19 pandemic. In 2021, during the COVID-19 pandemic, a sudden rise in patients with AMN was observed in our clinic. In this paper, 4 cases from a hospital in the south of the Netherlands are reported, all of which could directly be linked to a COVID-19 infection or vaccination against the corona virus. A search for similar cases in the PubMed database produced thirteen relevant reports, which revealed that a similar increase in cases of AMN, all linked to COVID-19, has been observed worldwide. Analysis of the literature revealed that AMN is seen more often during the pandemic and that AMN after COVID-19 happens at a significantly older age than typically reported. This is the largest case series of patients with AMN after COVID-19 infection or vaccination. With the ongoing pandemic and extensive vaccination programs, it is expected that cases of AMN will surge. It is important for ophthalmologists to be aware of this disease, especially since typical patient characteristics may differ.

Keywords: Acute macular neuroretinopathy; COVID-19; Vaccine.

Fig. 1

OCT scan of the right eye of patient A; the infra-red image (up) shows a paracentral lesion (arrow); on the OCT image (down), only subtle changes to the outer nuclear and photoreceptor layers are seen.

Fig. 2

OCT scan of the right eye of patient D; the infra-red image (up) shows a small paracentral lesion (arrow), visible on the OCT image (down) as changes to the outer nuclear and photoreceptor layers.