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

Figure 3 Multimodal imaging evolution of acute macular neuroretinopathy with paracentral acute middle maculopathy in the right eye of Case 3. A: Near-infrared imaging shows hyporeflective lesions within the macular area, indicative of the interplay between acute macular neuroretinopathy and paracentral acute middle maculopathy; B-D: Sequential optical coherence tomography (OCT) B-scans detail the progression of the lesion. Initially, hyperreflective lesions in the outer plexiform layer coexist with hyporeflective lesions in the ellipsoid zone/interdigitation zone (IZ) and hyperreflective lesions in the inner nuclear layer within the macular region. By 2 mon, the lesions in the IZ transition to hyporeflective foci, a change that persisted in subsequent follow-up evaluations; E-G: Tracked OCT angiography (OCTA) (Plex Elite 9000; Carl Zeiss Meditec, Inc., Dublin, CA, United States), targeting the deep capillary plexus, illustrates a gradual reduction in the flow signal (indicated by orange arrow), signifying a decrease in vascular density over the course of the follow-up.