Acute macular neuroretinopathy following COVID-19 infection: Three case reports

Figure 1 Multimodal imaging of the evolution of an acute macular neuroretinopathy lesion in the left eye of Case 1. A: Ultra widefield pseudocolor fundus photography (Optos PLC, Dunfermline, Scotland, United Kingdom) shows a rugby ball-like lesion within the macular region; B: Near-infrared reflectance imaging of a hyporeflective lesion directed towards the macula; C, F and I: Sequential optical coherence tomography (OCT) B-scans shows the progression of the lesion. Initially, the images show a hyporeflective external limiting membrane, a hyperreflective myoid zone, and a hyporeflective ellipsoid zone (EZ), alongside the collapse of the outer plexiform layer with hyperreflective Henle's fiber layer and loss of the interdigitation zone (IZ). Follow-up at 1 mon reveals persistence of the hyporeflective EZ and deterioration in the IZ, which remains the sole impairment after 6 mon; D, G and J: Tracked OCT-angiography (OCTA) (Plex Elite 9000; Carl Zeiss Meditec, Inc., Dublin, CA, United States), targeting the superficial capillary plexus, indicating no observable flow signal deficits throughout the follow-up period; E, H and K: Tracked OCTA (Plex Elite 9000; Carl Zeiss Meditec, Inc.) at the deep capillary plexus level, showing an emergence and subsequent exacerbation of flow signal deficits (indicated by orange arrow) at 1 mo and 6 mo.