COVID-19-Related Microvascular Changes May Lead to Acute Macular Neuroretinitis

SARS-COV-2 infection may lead to thrombotic and microvascular changes that may be responsible for acute macular neuroretinopathy (AMN), according to a poster presented at the 2023 Southeastern Educational Congress of Optometry (SECO) meeting in Atlanta from March 1 to 5.

AMN, which presents primarily in women, creates transient visual disturbances and can be identified by reddish lesions surrounding the fovea. Optical coherence tomography (OCT) assessment reveals photoreceptor integrity line (PIL) disruptions with hyperreflective plaques among patients with this condition. AMN may be linked with a lower flow in the capillary plexus and have apoptotic, immune complex-mediated, and ischemic triggers. It shares similar signs with idiopathic central serous chorioretinopathy (ICSC), paracentral acute middle maculopathy (PAMM), white dot syndromes, and traumatic maculopathy. Risk factors include oral contraceptive use, febrile illness, trauma, and sympathomimetic medications.

Patients with AMD who have COVID-19 tend to have ocular abnormalities, especially if they have severe systemic manifestations or abnormal blood test results. Thrombotic and microvascular complications resulting from SARS-COV-2 infection can involve the retina, according to the poster presenters, which included Mariana Ferraz, OD, Diana Shechtman, OD, and Brendan Girschek, MD.

There are no clear evidence-based treatment options for AMN and the outcome following COVID-19 is unknown. Some management strategies include discontinuation of oral contraception, anti-vascular endothelial growth factor (VEGF) treatment in cases that involve macular edema, and fibrinolytic therapy, which should be limited due to associations with acute respiratory distress syndrome. AMN can resolve spontaneously — case studies highlighted by the poster presenters resulted in symptomatic improvements within 1 to 2 months in 2 patients.