Acute Macular Neuroretinopathy after Coronavirus Disease 2019 Infection

Acute macular neuroretinopathy (AMN) is a rare, poorly understood retinal disease that affects the outer retina. Recent studies reported that the onset of AMN is associated with coronavirus disease 2019 (COVID-19) infection. However, it still lacks thorough evaluation regarding the clinical features of AMN after COVID-19 infection. Retrospective cohort study. This study involved online registration of patients who were diagnosed with AMN after rapid antigen or polymerase chain reaction tests confirmed COVID-19 infections from December 2022 to March 2023. We interviewed all patients and completed an evaluation survey that recorded age, sex, menstruation pattern, medical history, doses of COVID-19 vaccination, symptom onset (days after fever onset), symptoms, and treatment measures. The association between clinical characteristics and baseline visual acuity was investigated. Demographic and clinical characteristics of AMN after COVID-19 infection. A total of 116 eyes from 66 patients were included in the present study. The average ± standard deviation age was 30.4 ± 6.7 years, and 81.8% of patients were female. The average time to ocular symptom onset was 2.62 ± 1.88 days after fever onset. Scotomas (87.9%) were the most common symptoms reported by patients, whereas 25.9% and 1.7% of eyes had blurry vision and photopsia, respectively. Of the 116 eyes, 80.2%, 60.3%, 26.7%, 10.3%, and 3.4% showed ellipsoid zone (EZ) disruption, hyperreflectivity of outer nuclear layer (ONL), hyperreflectivity of Henle layer, hyperreflectivity of the outer plexiform layer (OPL), and macular edema, respectively. A history of smoking (correlation coefficient = 0.12; 95% confidence interval [CI], 0.00–0.24), macular edema (coefficient = 0.14; 95% CI, 0.00–0.88), hyperreflectivity of the OPL (coefficient = 0.16; 95% CI, 0.08–0.24), hyperreflectivity of the Henle layer (coefficient = 0.08; 95% CI, 0.03–0.14), and EZ disruption (coefficient = 0.07; 95% CI, 0.00–0.13) were associated with worse logarithm of the minimum angle of resolution visual acuity at baseline. Acute macular retinopathy after COVID-19 infection is more common in young females. Hyperreflectivity of the ONL and EZ disruption are the most common OCT features of AMN. Macular edema, hyperreflectivity of the OPL, hyperreflectivity of the Henle layer, EZ disruption, and a history of smoking are associated with worse visual acuity at baseline. The authors have no proprietary or commercial interest in any materials discussed in this article.