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Acute macular neuroretinopathy: pathogenetic insights from optical coherence tomography angiography
  1. Giuseppe Casalino1,2,
  2. Alessandro Arrigo1,
  3. Francesco Romano1,
  4. Marion R Munk3,
  5. Francesco Bandello1,
  6. Maurizio Battaglia Parodi1
  1. 1 Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
  2. 2 Moorfields Eye Hospital NHS Foundation Trust, London, UK
  3. 3 Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Giuseppe Casalino, Department of Ophthalmology, Ospedale San Raffaele, Milan 20132, Italy; peppecasalino{at}


Aim To describe the optical coherence tomography angiography (OCT-A) features of patients affected by acute macular neuroretinopathy (AMN).

Methods This is a prospective, observational, cross-sectional study. Multimodal imaging, including spectral domain OCT (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) and 6×6 mm swept source OCT-A (ZEISS PLEX Elite 9000; ZEISS, Dublin, California), was performed on all patients. The primary outcome measure was assessment of the vascular alterations of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC). A segmentation of the AMN lesions using enface OCT images of photoreceptors-retinal pigment epithelium complex was used to discriminate intralesional and extralesional regions on the OCT-A enface slabs of the DCP and CC reconstructions. Each OCT-A slab was imported into ImageJ V.1.50 and digitally binarised for quantitative analyses.

Results Overall, seven patients (mean age 19.4±3.2 years, six women) affected by AMN were included. The mean best-corrected visual acuity was 0.00±0.00 logarithm of the minimum angle of resolution. Twelve healthy age-matched subjects (mean age 22±3.4 years, 10 women) represented the control group. The quantitative analysis of global vessel densities showed that the CC vessel density was significantly lower in patients with AMN (0.495±0.03) compared with the age-matched controls (0.545±0.02) (corrected p=0.0003). The intralesional vessel density of the DCP was 0.349±0.04 in AMN and vs 0.497±0.02 in the controls (corrected p=0.0002).

Conclusions Our study confirmed inner choroidal vascular flow void as a possible pathogenetic mechanism of AMN. We also found a focal impairment of the DCP within the AMN lesions. Future studies are needed to clarify which is the primary location of the vascular insult in this condition.

  • en-face optical coherence tomography
  • near-infrared reflectance imaging
  • optical coherence tomography angiography.
  • acute macular neuroretinopathy

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  • Contributors All authors contributed substantially to this manuscript and approved the current version. GC and AA contributed equally and should be both considered as first author. Study design: GC, AA, MBP. Data acquisition: GC, AA, FR. Data interpretation: GC, AA, MRM, MBP, FB. Writing the manuscript: GC, AA, MRM, MBP. Statistical analysis: AA, FR. Critical review and approval of the manuscript: GC, MRM, MBP, FB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The protocol was approved by the Institutional Review Board of San Raffaele Hospital, and the procedures adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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