June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Acute Macular Neuroretinopathy: New Insights into Pathogenesis and Association with Retinal Capillary Ischemia
Author Affiliations & Notes
  • Ehsan Rahimy
    Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, CA
  • David Sarraf
    Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, CA
    Greater LA VA Healthcare Center, Los Angeles, CA
  • Amani Fawzi
    Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL
  • Elliott Sohn
    Ophthalmology, University of Iowa Hospital, Iowa City, IA
  • Irene Barbazetto
    Vitreous Retina Macula Consultants of New York, New York, NY
    Ophthalmology, New York University School of Medicine, New York, NY
  • David Zacks
    Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, MI
  • Robert Mittra
    VitreoRetinal Surgery, PA, Minneapolis, MN
  • Sarah Mrejen
    Vitreous Retina Macula Consultants of New York, New York, NY
    Ophthalmology, New York University School of Medicine, New York, NY
  • Naomi Goldberg
    Ophthalmology, Mount Sinai School of Medicine, New York, NY
  • K Bailey Freund
    Vitreous Retina Macula Consultants of New York, New York, NY
    Ophthalmology, New York University School of Medicine, New York, NY
  • Footnotes
    Commercial Relationships Ehsan Rahimy, None; David Sarraf, Genentech (F), Regeneron (F), Allergan (F), Alcon (F), DORC (F); Amani Fawzi, None; Elliott Sohn, None; Irene Barbazetto, None; David Zacks, ONL Therapeutics, LLC (I), University of Michgian (P); Robert Mittra, None; Sarah Mrejen, None; Naomi Goldberg, None; K Bailey Freund, Genentech (C), Regeneron (C), ThromboGenics (C), Bayer (C), DigiSight (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3607. doi:
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    • Get Citation

      Ehsan Rahimy, David Sarraf, Amani Fawzi, Elliott Sohn, Irene Barbazetto, David Zacks, Robert Mittra, Sarah Mrejen, Naomi Goldberg, K Bailey Freund; Acute Macular Neuroretinopathy: New Insights into Pathogenesis and Association with Retinal Capillary Ischemia. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3607.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To report novel multimodal imaging findings in acute macular neuroretinopathy (AMN) which implicate an underlying ischemic pathogenesis. A simple classification system is proposed to reflect the location of SD-OCT lesions in AMN that affect the outer plexiform layer (OPL)/inner nuclear layer (INL) junction of the inner macula (Type 1) versus the OPL/outer nuclear layer (ONL) region of the outer macula (Type 2).

 
Methods
 

Retrospective observational case series reviewing clinical and imaging data from 8 patients (10 eyes) with AMN. All patients demonstrated classic parafoveal, dark grey, wedge-like lesions with NIR reflectance and characteristic abnormalities with SD-OCT imaging that were classified as Type 1 or 2 in relation to the location of the lesion above (Type 1) or below (Type 2) the OPL.

 
Results
 

Of the 8 patients, 5 were female and 3 were male, averaging 46.8 years in age (range, 21-65). Seven of the individuals were Caucasian, and the other was African American. The retinal lesions were unilateral in all but 2 cases. Visual acuity (VA) in the affected eyes at the time of presentation ranged from 20/15 to 20/30. After an average follow-up of 9.5 weeks (range, 3-30), VA ranged from 20/20 to 20/30. Five eyes (4 patients) had Type 1 lesions and 5 eyes (4 patients) had Type 2 lesions. While Type 1 lesions lead to thinning of the INL, Type 2 lesions resulted in thinning of the ONL. Type 2 lesions were always associated with significant outer macular defects including attenuation of the inner segment/outer segment (IS/OS) and outer segment/retinal pigment epithelium (OS/RPE) bands, whereas Type 1 lesions failed to disrupt the integrity of the IS/OS junction.

 
Conclusions
 

The diagnosis of AMN has vastly improved with the integration of multimodal imaging. Two types of AMN lesions may be seen with SD-OCT occurring above and below the OPL: Type 1. Hyperreflective bands in the OPL/INL region with subsequent INL thinning, and Type 2. Hyperreflective bands in the OPL/ONL region with subsequent ONL thinning. Type 2 lesions may be associated with concomitant defects of the IS/OS band. We propose that each of these lesions may be explained by occlusion of the superficial capillary plexus (SCP) (Type 1) or deep capillary plexus (DCP) (Type 2) located in the innermost and outermost portion of the INL respectively immediately adjacent to each corresponding lesion type.

     
Keywords: 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 688 retina  
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