Multimodal imaging characteristics of acute macular neuroretinopathy

Kumar Saurabh; Rupak Roy; Dhaivat Shah; Sugandha Goel; Samarth Mishra; Deepak Senger

doi:10.4103/ijo.IJO_969_18

PHOTO ESSAY

Year : 2019 | Volume : 67 | Issue : 3 | Page : 403-404

Multimodal imaging characteristics of acute macular neuroretinopathy

Kumar Saurabh¹, Rupak Roy², Dhaivat Shah³, Sugandha Goel³, Samarth Mishra³, Deepak Senger²
¹ Retina Services, Kamalnayan Bajaj Sankara Nethralaya, Kolkata, West Bengal, India
² Retina Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
³ Sri Bhagwan Mahavir Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission	19-Jul-2018
Date of Acceptance	25-Oct-2018
Date of Web Publication	18-Feb-2019

Correspondence Address:
Dr. Kumar Saurabh
Kamalnayan Bajaj Sankara Nethralaya, DJ16, Action Area 1D, New Town, Kolkata - 700 156, West Bengal
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ijo.IJO_969_18

Abstract

Keywords: Acute macular neuroretinopathy, autofluorescence, multicolor imaging, multimodal imaging, near infrared autofluorescence

How to cite this article:
Saurabh K, Roy R, Shah D, Goel S, Mishra S, Senger D. Multimodal imaging characteristics of acute macular neuroretinopathy. Indian J Ophthalmol 2019;67:403-4

How to cite this URL:
Saurabh K, Roy R, Shah D, Goel S, Mishra S, Senger D. Multimodal imaging characteristics of acute macular neuroretinopathy. Indian J Ophthalmol [serial online] 2019 [cited 2019 May 24];67:403-4. Available from: http://www.ijo.in/text.asp?2019/67/3/403/252434

Acute macular neuroretinopathy (AMN) usually presents as brown-red lesion near fovea.^[1],[2] Spectral domain optical coherence tomography (SDOCT) shows initial thickening of the outer plexiform layer (OPL), eventual thinning of outer nuclear layer (ONL) and focal disruptions of external limiting membrane (ELM) and ellipsoid zone (EZ).^[1] We herein report the multicolor, reflectance, and autofluorescence imaging characteristics of AMN.

Case Report

A 19-year-old healthy female presented with complaint of seeing black spot in front of her left eye for 1 week. The left eye showed a faint yellowish brown-wedge-shaped depigmentation inferonasal to fovea [Figure 1]a. Multicolor image showed a zone of pale-pink discoloration with loss of perifoveal greenish hue [Figure 1]b. SDOCT line scan through the lesion showed focal thickening of OPL with thinning of underlying ONL and focal disruption of ELM [Figure 1]c. Infrared channel of multicolor imaging aimed at picking the outer retinal lesions showed zone of hyperreflectance [Figure 1]d. The pseudocolor encoding for this channel is red which explains the pinkish discoloration of lesion amidst the greenish perifoveal hue on multicolor image.^[3] Based on these findings, a diagnosis of AMN was made. Blue autofluorescence (BAF) image showed wedge-shaped hyperautofluorescence interspersed with hypoautofluorescent zones [Figure 2]a.

Figure 1: (a) Color fundus photograph of left eye showing an area of yellowish brown depigmentation inferonasal to fovea (white circle); (b) multicolor composite showing loss of perifoveal greenish hue over the area of acute macular neuroretinopathy lesion along with pinkish discoloration (white circle); (c) line scan SDOCT image through the lesion showing thickening of outer plexiform layer (OPL) on the nasal side of fovea compared with the temporal side (white arrow). The difference in the OPL thickness can be clearly made out in blown up image in the lower panel (yellow rectangle) comparing with the temporal OPL (yellow triangle). Note the subtle zone of discontinuity of external limiting membrane beneath the thickened OPL (red triangle) and thinning of outer nuclear layer; (d) infrared reflectance image showing hyperreflectance corresponding to the AMN lesion (white circle)

Click here to view

Figure 2: (a) Blue autofluorescence image of AMN lesion (yellow circle) showing an area of hyperautofluorescence interspersed with darker zones of hypoautofluorescence; (b) near-infrared autofluorescence image of AMN (yellow circle) showing hypoautofluorescence over the AMN lesion which is darker than the adjacent foveal and macular hyperautofluorescence

Click here to view

Discussion

AMN leads to variable disruption of photoreceptors seen as disruption of ELM and EZ. The resulting stress of retinal pigment epithelium (RPE) may present as hyperautofluorescence while interspersed hypoautofluorescent regions suggest damaged RPE. Near-infrared autofluorescence (NIR-AF) image revealed area of hypoautofluorescence over the AMN lesion [Figure 2]b. Both BAF and NIR-AF depict RPE damage in this case which is a feature of AMN.^[4]

Our report depicts the imaging signatures of AMN using newer imaging modalities like multicolor, BAF, and NIR-AF. Studies with larger number of AMN cases will further validate our findings.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Lee SY, Cheng JL, Gehrs KM, Folk JC, Sohn EH, Russell SR, et al. Choroidal features of acute macular neuroretinopathy via optical coherence tomography angiography and correlation with serial multimodal imaging. JAMA Ophthalmol 2017;135:1177-83.
2.	Bhavsar KV, Lin S, Rahimy E, Joseph A, Freund KB, Sarraf D, et al. Acute macular neuroretinopathy: A comprehensive review of the literature. Surv Ophthalmol 2016;61:538-65.
3.	Tan AC, Fleckenstein M, Schmitz-Valckenberg S, Holz FG. Clinical application of multicolor imaging technology. Ophthalmologica 2016;236:8-18.
4.	Greenstein VC, Schuman AD, Lee W, Duncker T, Zernant J, Allikmets R. Near-infrared autofluorescence: Its relationship to short-wavelength autofluorescence and optical coherence tomography in recessive stargardt disease. Invest Ophthalmol Vis Sci 2015;56:3226-34.