Abstract
Purpose :
Highlight cases of maculopathy associated with migraine and history of COVID-19 infection.
Methods :
Retrospective case series of three patients with maculopathy seen at the University of Minnesota between 1/2022 - 1/2023. All patients had ocular coherence tomography (OCT), OCT-angiography (OCT-A), fundus autofluorescence (FAF), and fluorescein angiography (FA).
Results :
Patient #1: A 27-year-old female with a migraine history and attention deficit hyperactivity disorder (ADHD) presented with a central scotoma several days after infection with COVID-19. OCT revealed a focal ellipsoid zone disruption with otherwise normal OCT-A, autofluorescence, and fluorescein angiography. The patient received a course of oral prednisone with gradual normalization of the ellipsoid zone along with subjective improvement in her scotoma.
Patient #2: A 25-year-old female with a migraine history presented with bilateral central scotomas following a high fever secondary to COVID-19 infection. OCT revealed bilateral ellipsoid zone disruption and subtle retinal pigment epithelium irregularities with normal OCT-A. She received a course of oral prednisone, with interval improvement in OCT irregularities and subjective improvement in her visual symptoms.
Patient #3: A 19-year-old female with a history of migraine and scotoma in the left eye was referred for a worsening scotoma. There was a history of COVID-19 infection months prior. OCT revealed thinning of the inner retina in the nasal macula with a flow void in the deep plexus on OCT-A. FA showed late temporal disc margin hyperfluorescence but no vascular occlusions. Magnetic resonance imaging (MRI) of the brain and lab testing for other infectious, inflammatory, and thrombotic risk factors were negative. Multifocal electroretinogram (ERG) was normal but had a subtle reduction in pattern ERG amplitude in the left eye.
Conclusions :
We identified three patients with scotomas secondary to maculopathy in the setting of migraine and COVID-19 infection. In two patients, the time course of disease was closely tied to their infection, although migraine frequency and proximity to presentation was variable. These cases underscore the importance of multimodal imaging in identifying subtle macular pathology.
This abstract was presented at the 2023 ARVO Imaging in the Eye Conference, held in New Orleans, LA, April 21-22, 2023.