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ACUTE MACULAR NEURORETINOPATHY AS THE PRESENTING MANIFESTATION OF COVID-19 INFECTION

Supplemental Digital Content is Available in the Text. Acute macular neuroretinopathy is a condition characterized by an acute paracentral scotoma and subsequent vision loss. Acute macular neuroretinopathy may be triggered by many disorders including viral infections, such as influenza. However, this is to our knowledge the first report of AMN associated with COVID-19 infection. Purpose: To describe a case of sudden visual loss from acute macular neuroretinopathy (AMN) as the presenting manifestation of active COVID-19 infection. Case report: During the quarantine period of the COVID-19 pandemic, a 70-year-old man presented with a 1-day history of a paracentral scotoma of the left eye associated with diaphoresis. Four days later, the patient developed fever (38°C) followed by cough. Oral and nasal swab PCR testing was positive for COVID-19. Visual acuity in the day of presentation was 20/20 in the right eye and 20/100 in the left eye. Multimodal retinal imaging was unremarkable in the right eye, but cross-sectional optical coherence tomography displayed focal hyperreflectivity at the level of the outer nuclear layer associated with disruption of the ellipsoid zone. The corresponding en face optical coherence tomography revealed an inferonasal hyperreflective parafoveal lesion. At 1 month of follow-up, tracked optical coherence tomography of the macula showed resolution of the hyperreflective signal, thinning of the outer nuclear layer, and near-complete recovery of ellipsoid zone integrity. Conclusion: Patients with COVID-19 may rarely present with signs and symptoms of ocular disease. This case report describes a case of sudden visual loss caused by acute macular neuroretinopathy as the presenting manifestation of active COVID-19 infection.