7/23/2019 Acta Ophthalmol Scand 2000 Feigl-1 http://slidepdf.com/reader/full/acta-ophthalmol-scand-2000-feigl-1 1/4 — ACTA OPHTHALMOLOGICA SCANDINAVICA 2000 Optical coherence tomography OCT) n acute macular neuroretinopathy Beatrix Feigl and Anton Haas Department of Ophthaltnology, University of Graz, Austria ABSTRACT. Purpose: To evaluate the value of ocular coherence tomography (OCT) concern- in;^ diagnosis and pathogenesis of acute macular neuroretinopathy. Methods: A 33-year old woman complained of sudden onset of central scotomas in her right eye hecause of acute niacutar neuroretinopathy. We performed a direct ophthalmoscopy, a visual Held testing, a fluorescein angiography (FA) a multifocal ERG (mf-ERG) and an OCT. Re sults: We found typical paracentral scotoma in visual field testing, a normal FA and nif-KRG in her right eye. In OCT there was a hand of higher reflectivity (115 ^m) overlying an intact hand corresponding to the retinal pigment epithel- ium (RPE)/ choriocapillaris complex. Retinal thickness was within the normal range. Conclusion: OCT can he an additional valuahle tool in acute macular neuroreti- nopathy us it is a disease with discrete pathology and often normal results in other diagnostic tests. Key words: optical coherence tomography - OCT - acute macular neuroretinopathy Acta Ophthalmol. Scand. 2000: 78: 714-716 Copyright SI cta Ophlhalmot Scard 2000 tSSN 1395 3907 A cule macular neuroretinopathy was .first discribed by Bos and Deut- matin in 1975 an d is a rare uni-or bilat- eral tTiaculopathy of unknown etiology itivolving mainly young women between the ages of 20 and 30 years. Most patients experience sudden onset of paracentral scototnas with preserved good visual acu- ity, often with a preceding flu-like disease (Bos Deutmann1975; Miller et al. 1989). Opiilhalmoscopy shows wedge- shaped, red-brown lesions arranged radi- ally in the macula. The lesions are sug- gested to be located in the outer retina, FA and standard electroretinography (Sieving et al. 1984) typically are nortnal. whereas Amsler grid and visual fields re - veal parafoveal scotomas. Visual deficit does not improve as persistance of macul- opathy an d scotomas have been de- scribed up to 9 years (Desai et al.l993) (e.g steroids) has not been proven to date. Case Report A 33-year-old female patient complained about sudden visual disturbances with central, greyish, swirling scotomas on her right eye. A week before she had suffered from a flu-Uke disease with fever, swelling of the left submandibular lytnph nodes, and pain in her joints. Other than taking oral antibiotics after the onset of v'isual problems, she did not receive any treat- ment. Visual acuity was 20/20 on her right eye; on her left eye she had a decreased visual acuity (20/100) because of squint- ing as a child and amblyopia. Amsler right eye. Direct ophthalmoscopy vealed red-brown lesions (Fig. 1) in macula area and visual field test (Octopus M2 . Interzeag. Switzerla showed paracentral scotomas (Fig while the results on her left eye w within the normal range. First order K nels of mf-ERG (Reti scan. Roland C suU. Wiesbaden. Germany) were norm Fig, 1. Fundus examiniition showed a reddish-brown lesion on the right eye.
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Fig. 3. a. OCT resu lts (longitu dinal scan and a rea showed on Fig. 1) on her right eye revealed a hyperrefleciivity (arrow ) above an und isturbe d Rl 'E/
chorio capillaris b and wh ich spares the foveal depression, b. Longitud inal O CT scan thro ugh the fovea on her left eye was within the norm al ran ge.