Acute macular neuroretinopathy as the presenting manifestation of COVID-19 infection.

Preti, Rony C; Zacharias, Leandro C; Cunha, Leonardo P; Monteiro, Mario L R

PURPOSE To describe a case of sudden visual loss from acute macular neuroretinopathy (AMN) as the presenting manifestation of active Covid-19 infection. CASE REPORT During the quarantine period of the COVID-19 pandemic, a 70-year-old man presented with a 1-day history of a paracentral scotoma of the left eye (OS) associated with diaphoresis. Four days later, the patient developed fever (38° C) followed by cough. Oral and nasal swab PCR testing was positive for COVID-19. Visual acuity in the day of presentation was 20/20 in OD and 20/100 in OS. Multimodal retinal imaging was unremarkable in OD but cross-sectional OCT displayed focal hyperreflectivity at the level of the outer nuclear layer associated with disruption of the ellipsoid zone (EZ). The corresponding en face OCT revealed an inferonasal hyperreflective parafoveal lesion. At 1 month of follow-up, tracked OCT of the macula showed resolution of the hyperreflective signal, thinning of the outer nuclear layer, and near-complete recovery of EZ integrity. CONCLUSION Patients with Covid-19 may rarely present with signs and symptoms of ocular disease. This case report describes a case of sudden visual loss caused by AMN as the presenting manifestation of active Covid-19 infection.