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Review
. 2023;246(3-4):181-191.
doi: 10.1159/000533530. Epub 2023 Aug 11.

Clinical and Diagnostic Findings of Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy in the COVID-19 Era

Elias Premi  1   2 , Roberto Acampora  3   4 , Davide Salmi  5 , Ingrid Ilie  6 , Nadia Pagnoncelli  7 , Francesco Germano  8 , Greta Gandolfi  9 , Melvin Sanicas  10 , Adam Seed  11   12   13 , Benedict Michael  11   12   13 , Simone Donati  14 , Claudio Azzolini  14 , Francesco Lanfranchi  15
Affiliations
Review

Clinical and Diagnostic Findings of Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy in the COVID-19 Era

Elias Premi et al. Ophthalmologica. 2023.

Abstract

Background: Growing evidence suggests an association between the infection from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and eye disorders. The aim of this review was to analyze the clinical presentation and diagnostic features of acute macular neuroretinopathy (AMN) and paracentral acute middle maculopathy (PAMM) associated with COVID-19 infection. The features are then compared with previous reports regarding these retinal disorders, to recognize possible specific characteristics and to assess the role of multimodal ophthalmic imaging.

Summary: A literature search was performed by consulting PubMed, Scopus, and Embase. The following terms were searched: "(COVID-19 OR SARS-CoV-2 OR coronavirus) AND ([acute macular neuroretinopathy] OR [paracentral acute middle maculopathy])." Inclusion criteria were as follows: (1) publication date from January 31, 2020 to January 31, 2022; (2) English language; (3) original research or case report; (4) free full-text availability.Optical coherence tomography (OCT) findings in AMN patients were hyper-reflectivity (HR) of the outer plexiform layer, of the outer nuclear layer, and ellipsoid or interdigitation zones (EZ and IZ, respectively) disruption. In most cases, the presence of HR and EZ/IZ abnormalities resulted combined. When performed, OCT angiography (OCTA) identified attenuation of signal of the deep capillary plexus (DCP). The most common OCT finding in PAMM was an alteration of the inner nuclear layer, associated with other areas of HR, while no signs of EZ/IZ disruption were detected. When performed, OCTA showed the attenuation of signal of both the DCP and the superficial capillary plexus.

Key messages: In this review, we reported a case series of AMN and PAMM in patients with a previous or concomitant infection from SARS-CoV-2. The microvascular changes in these cases are highlighted by the OCTA scans. Even if we are far from the determination of a direct link between COVID-19 and these retinal disorders, we could hypothesize that the vascular alterations associated with SARS-CoV-2 infection could be a possible risk factor for both AMN and PAMM.

Keywords: Acute macular neuroetinopathy; COVID-19; Paracentral acute middle maculopathy; Retina; Severe acute respiratory syndrome coronavirus-2.

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Conflict of interest statement

E.P., R.A., D.S., I.A.I., N.P., F.G., G.G., M.S., A.S., S.D., C.A., and F.L. declare no conflict of interest on this topic. B.D.M. is supported to conduct COVID-19 neuroscience research by the UKRI/MRC (MR/V03605X/1); B.D.M. is also supported for additional neurological inflammation research due to viral infection by grants from the MRC/UKRI (MR/V007181//1), MRC (MR/T028750/1), and Wellcome (ISSF201902/3).

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram showing the process of data collection and selection.
See this image and copyright information in PMC

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