A 73-year-old man had acute vision loss in his right eye, following pacemaker dysfunction during the early postimplantation period. He had second-degree atrioventricular block. Best-corrected visual acuity was 20/63 OD. Anterior segment examination was unremarkable. Humphrey visual field 10-2 testing revealed a paracentral scotoma of the right eye. Fundus photography revealed a brown-reddish foveal reflex (Figure 1A). Near-infrared imaging showed a parafoveal multilobular hyporeflective area (Figure 1B). Spectral-domain optical coherence tomography (SD-OCT) (Spectralis HRA and SD-OCT; Heidelberg Engineering GmbH) demonstrated hyperreflectivity of the outer plexiform layer and Henle fiber layer associated with subretinal fluid, consistent with acute macular neuroretinopathy (Figure 1D). Optical coherence tomography angiography (OCT-A) (Spectralis HRA and SD-OCT) identified lobular-shaped deep capillary flow loss that colocalized with the lesions seen on near-infrared imaging and SD-OCT (Figure 1C). Areas of relative brighter signal were along the outer border of the nonperfused regions. Superficial capillary plexus, choriocapillaris, and choroid showed no vascular abnormalities. Two weeks later, SD-OCT imaging showed resolution of the subretinal fluid, outer nuclear layer and Henle fiber layer hyperreflectivity, and underlying disruption of the ellipsoid and interdigitation zones (Figure 2A). Simultaneously, OCT-A revealed centripetal recovery of the deep capillary layer (Figure 2A). Four weeks later, best-corrected visual acuity was 20/20 OD. Humphrey visual field 10-2 testing normalized. Spectral-domain OCT showed outer plexiform and outer nuclear layer thinning compared with the fellow eye with persistent ellipsoid and interdigitation zones alterations (Figure 2B). Optical coherence tomography angiography demonstrated complete normalization of the deep capillary plexus (Figure 2B).
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Ramtohul P, Comet A, Denis D. Optical Coherence Tomography Angiography Recovery Pattern of Acute Macular Neuroretinopathy. JAMA Ophthalmol. 2020;138(2):221–223. doi:10.1001/jamaophthalmol.2019.5066
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