Objective To investigate the clinical characteristics of acute macular neuroretinopathy (AMNR) and the therapy to treat it. Methods This was a retrospective study. The clinical data of 16 patients (25 eyes) diagnosed with acute macular neuroretinopathy from December 2007 to March 2012 were analyzed. The patients (12 males and 4 females) ranged in age from 24 to 72 years with an average age of 51.1±12.7 years. Visual acuity ranged from light perception (LP) to 1.2. Color fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed on these patients. The etiology and the pathogenesis as well as the therapy and visual prognosis of AMNR were evaluated. Results Among the 16 patients, 9 patients were bilateral and 7 were unilateral. All 16 patients (25 eyes) showed grey-yellow lesions in the macular area. FFA revealed that the optic disc was stained in the late stages. Some patients showed the dilatation of micro-retinal veins with dye leakage in the late phases of FFA. ICGA revealed poor perfusion in the macula and the posterior area of the retina. The OCTs of all patients showed the inner segment/outer segment-choriocapillary (IS/OS-CC) band was partially absent with a thickened outer plexiform layer overlying these areas in different degrees. Some patients showed local neurosensory epithelium detachment in OCT images. The resilient packet ring (RPR) and treponema pallidum hemagglutination assay (TPHA) tests were positive in all 16 patients. HIV was simultaneously positive in one patient. Ten patients (14 eyes) agreed to anti-syphilis therapy. The follow-up ranged from 2 weeks to 2 years. The grey-yellow lesions disappeared in 9 patients (12 eyes) and visual acuity improved to 1.0 in 9 eyes. Only one patient (2 eyes) did not have an improvement in visual acuity due to a short follow-up of 2 weeks. Six other patients (11 eyes) were lost and failed to return for unknown reasons. Conclusion Syphilis infection is one of the many causes of AMNR. The main pathological abnormality is located at the outer retina and IS-OS junction. Immunologic examinations such as spirochaeta pallida and HIV are very important in the fundus clinic. Treatment with penicillin resulted in a rapid cure and always had a good prognosis.
Bos PJ, Deutman AF. Acute macular neuroretinopathy[J]. Am J Ophthalmol,1975,80:573-584.
[2]
Turbeville SD, Cowan LD, Gass JD. Acute macular neuroretinopathy: a review of the literature[J]. Surv Ophthalmol,2003,48:1-11.
[3]
Makino S, Tampo H. Acute macular neuroretinopathy in a 15-year-old boy: optical coherence tomography and visual acuity findings[J]. Case Rep Ophthalmol,2014,8,5:11-15.
[4]
Gass JD, Agarwal A, Scott IU. Acute zonal occult outer retinopathy: a long-term follow-up study[J]. Am J Opthalmol,2002,134:329-339.
[5]
Gass JD. The acute zonal outer retinopathies[J]. Am J Ophthalmol,2000,130:655-657.
[6]
Grover S, Brar VS, Murthy RK, et al. Infrared imaging and spectral-domain optical coherence tomography findings correlate with microperimetry in acute macular neuroretinopathy: a case report[J]. J Med Case Rep,2011,5:536.
[7]
Heckenlively JR, Ferreyra HA. Autoimmune retinopathy: a review and summary[J]. Semin Immunopathol,2008,30:127-134.
[8]
Mantel I, Ramchand KV, Holder GE, et al. Macular and retinal dysfunction of unknown origin in adults with normal fundi: Evidence for an autoimmune pathophysiology[J]. Exp Mol Pathol,2008,84:90-101.