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New associations of classic acute macular neuroretinopathy
  1. Marion R Munk1,2,
  2. Lee M Jampol1,
  3. Eduardo Cunha Souza3,
  4. Gabriel Costa de Andrade4,5,
  5. Daniel D Esmaili6,
  6. David Sarraf7,
  7. Amani A Fawzi1
  1. 1Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
  3. 3University of Sao Paulo, Sao Paulo, Brazil
  4. 4Retina Clinic, São Paulo, Brazil
  5. 5Department of Ophthalmology, Federal University of São Paulo–UNIFESP/EPM, São Paulo, Brazil
  6. 6Retina-Vitreous Associates Medical Group, Los Angeles, California, USA
  7. 7Jules Stein Eye Institute, UCLA Greater LA VA Healthcare Center, Los Angeles, California, USA
  1. Correspondence to Dr Amani A Fawzi, Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, 645 N Michigan Avenue, Suite 440, Chicago, IL 60611, USA; afawzimd{at}


Purpose To describe novel underlying associations of classic acute macular neuroretinopathy (AMN).

Methods Multimodal imaging case series evaluating patients with classic AMN lesions and previously unreported underlying aetiologies.

Results Six patients were included (five women, one man, mean age 30±7 years). Mean distance best corrected visual acuity at initial presentation was 0.21±0.3 logMAR (mean Snellen acuity: 20/30, range 20/15–20/100) and at last follow-up visit 0.09±0.17 logMAR (Snellen acuity: 20/20, range 20/15–20/60). All cases but one had bilateral lesions and showed typical parafoveal hyporeflective lesions on infrared imaging, which corresponded to the hyper-reflectivity in the Henle's layer with attenuation of the external limiting membrane, the ellipsoid zone and interdigitation zone. Underlying diseases included thrombocytopenia and anaemia associated with dengue fever, acute lymphoblastic leukaemia, chronic kidney disease and ulcerative colitis, while Valsalva-like manoeuvre was found to be a potential trigger. Other novel associations included the use of lisdexamphetamine.

Conclusions Classic AMN may be associated with leukaemia, dengue fever, ulcerative colitis and chronic kidney disease, probably as a result of chorioretinal hypoxia in the setting of thrombocytopenia and anaemia. Adrenergic agonists such as lisdexamphetamine may also contribute to the manifestation of AMN.

  • Imaging
  • Macula
  • Retina

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