SELECTIVE CONE PHOTORECEPTOR INJURY IN ACUTE MACULAR NEURORETINOPATHY

Purpose: To evaluate retinal structural and functional abnormalities in a patient with acute macular neuroretinopathy. Methods: An adaptive optics scanning light ophthalmoscope was used to image the photoreceptor mosaic and assess rod and cone structure. Spectral-domain optical coherence tomography was used to examine retinal lamination. Microperimetry was used to assess function across the macula. Results: Microperimetry showed reduced function of localized areas within retinal lesions corresponding to subjective scotomas. Spectral-domain optical coherence tomography imaging revealed attenuation of two outer retinal bands typically thought to reflect photoreceptor structure. Adaptive optics scanning light ophthalmoscope images of the photoreceptor mosaic revealed a heterogeneous presentation within these lesions. There were areas containing non-waveguiding cones and other areas of decreased cone density where the remaining rods had expanded to fill in the vacant space. Within these lesions, cone densities were shown to be significantly lower than eccentricity-matched areas of normal retina, as well as accepted histologic measurements. A 6-month follow-up revealed no change in rod or cone structure. Conclusion: Imaging of acute macular neuroretinopathy using an adaptive optics scanning light ophthalmoscope shows a preferential disruption of cone photoreceptor structure within the region of decreased retinal sensitivity (as measured by microperimetry). Adaptive optics–based imaging tools provide a noninvasive way to assess photoreceptor structure at a level of detail that is not resolved by use of conventional spectral-domain optical coherence tomography or other clinical measures.

[1]  Srinivas R. Sadda,et al.  ACUTE MACULAR NEURORETINOPATHY: Long-Term Insights Revealed by Multimodal Imaging , 2012, Retina.

[2]  P. Sieving,et al.  Acute macular neuroretinopathy: early receptor potential change suggests photoreceptor pathology. , 1984, The British journal of ophthalmology.

[3]  I. C. Munch,et al.  Acute macular neuroretinopathy in relation to anti‐thymocyte globulin infusion , 2012, Acta ophthalmologica.

[4]  D. M. Tait,et al.  Retinal imaging using commercial broadband optical coherence tomography , 2009, British Journal of Ophthalmology.

[5]  W. Amoaku,et al.  The multifocal electroretinogram in acute macular neuroretinopathy. , 2003, Archives of ophthalmology.

[6]  B. Lujan,et al.  Cone photoreceptor abnormalities correlate with vision loss in patients with Stargardt disease. , 2011, Investigative ophthalmology & visual science.

[7]  D. M. Tait,et al.  Arrested development: High-resolution imaging of foveal morphology in albinism , 2010, Vision Research.

[8]  Alfredo Dubra,et al.  Registration of 2D Images from Fast Scanning Ophthalmic Instruments , 2010, WBIR.

[9]  D. Sprunger,et al.  Multifocal electroretinographic evaluation of acute macular neuroretinopathy. , 2003, Archives of ophthalmology.

[10]  A. Bird,et al.  Acute macular neuroretinopathy. , 1989, Ophthalmology.

[11]  A. Dubra,et al.  Photoreceptor structure and function in patients with congenital achromatopsia. , 2011, Investigative ophthalmology & visual science.

[12]  J. J. McAnany,et al.  Clinical value, normative retinal sensitivity values, and intrasession repeatability using a combined spectral domain optical coherence tomography/scanning laser ophthalmoscope microperimeter , 2011, Eye.

[13]  D. M. Tait,et al.  Spectral domain optical coherence tomography and adaptive optics: imaging photoreceptor layer morphology to interpret preclinical phenotypes. , 2010, Advances in experimental medicine and biology.

[14]  C. Curcio,et al.  Aging of the human photoreceptor mosaic: evidence for selective vulnerability of rods in central retina. , 1993, Investigative ophthalmology & visual science.

[15]  A. Haas,et al.  Optical coherence tomography (OCT) in acute macular neuroretinopathy. , 2000, Acta ophthalmologica Scandinavica.

[16]  A. Roorda,et al.  Observation of cone and rod photoreceptors in normal subjects and patients using a new generation adaptive optics scanning laser ophthalmoscope , 2011, Biomedical optics express.

[17]  Austin Roorda,et al.  Outer retinal structure in patients with acute zonal occult outer retinopathy. , 2012, American journal of ophthalmology.

[18]  J. Duker,et al.  Comparison of ultrahigh- and standard-resolution optical coherence tomography for imaging macular hole pathology and repair. , 2004, Ophthalmology.

[19]  Jessica I. Wolfing,et al.  Retinal microscotomas revealed with adaptive-optics microflashes. , 2006, Investigative ophthalmology & visual science.

[20]  David Williams,et al.  In vivo imaging of the photoreceptor mosaic of a rod monochromat , 2008, Vision Research.

[21]  A. Dubra,et al.  Reflective afocal broadband adaptive optics scanning ophthalmoscope , 2011, Biomedical optics express.

[22]  S. Grover,et al.  Infrared imaging and spectral-domain optical coherence tomography findings correlate with microperimetry in acute macular neuroretinopathy: a case report , 2011, Journal of medical case reports.

[23]  David Williams,et al.  Functional photoreceptor loss revealed with adaptive optics: an alternate cause of color blindness. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[24]  W. Chan,et al.  Longitudinal findings of acute macular neuroretinopathy with multifocal electroretinogram and optical coherence tomography , 2005, Clinical & experimental ophthalmology.

[25]  T. Hwang,et al.  Acute macular outer retinopathy (AMOR): a reappraisal of acute macular neuroretinopathy using multimodality diagnostic testing. , 2011, Archives of ophthalmology.

[26]  T. Sakamoto,et al.  Atypical presentation of acute macular neuroretinopathy with tiny parafoveal reddish-brown lesions , 2011, Japanese Journal of Ophthalmology.

[27]  Maureen Neitz,et al.  Assessing retinal structure in complete congenital stationary night blindness and Oguchi disease. , 2012, American journal of ophthalmology.

[28]  K. Freund,et al.  OUTER RETINAL ABNORMALITIES IN ACUTE MACULAR NEURORETINOPATHY , 2011, Retina.

[29]  E. Hughes,et al.  Acute macular neuroretinopathy: anatomic localisation of the lesion with high-resolution OCT , 2009, Eye.

[30]  S. Asrani,et al.  Optical coherence tomography in the eyes of normal children. , 2009, Archives of ophthalmology.

[31]  A. Roorda,et al.  Cone structure in patients with usher syndrome type III and mutations in the Clarin 1 gene. , 2013, JAMA ophthalmology.

[32]  A. Dubra,et al.  Subclinical photoreceptor disruption in response to severe head trauma. , 2012, Archives of ophthalmology.

[33]  W. Inhoffen,et al.  Visualization and follow-up of acute macular neuroretinopathy with the Spectralis® HRA+OCT device , 2010, Graefe's Archive for Clinical and Experimental Ophthalmology.

[34]  F. Holz,et al.  Early spectral-domain optical coherence tomography findings in acute macular neuroretinopathy. , 2012, Retina.

[35]  P. Gastaud,et al.  Acute macular neuroretinopathy: contribution of spectral-domain optical coherence tomography and multifocal ERG , 2011, Graefe's Archive for Clinical and Experimental Ophthalmology.

[36]  W. T. Shults,et al.  ANNULAR MACULAR NEURORETINOPATHY AND MULTIFOCAL ELECTRORETINOGRAPHIC AND OPTICAL COHERENCE TOMOGRAPHIC FINDINGS , 2004, Retina.

[37]  C. Curcio,et al.  ANATOMICAL CORRELATES TO THE BANDS SEEN IN THE OUTER RETINA BY OPTICAL COHERENCE TOMOGRAPHY: Literature Review and Model , 2011, Retina.

[38]  Christopher S. Langlo,et al.  Repeatability of In Vivo Parafoveal Cone Density and Spacing Measurements , 2012, Optometry and vision science : official publication of the American Academy of Optometry.

[39]  L. Cowan,et al.  Acute macular neuroretinopathy: a review of the literature. , 2003, Survey of ophthalmology.

[40]  M. El-Dairi,et al.  A shot of adrenaline. , 2009, Survey of ophthalmology.

[41]  Jennifer J. Hunter,et al.  Imaging retinal mosaics in the living eye , 2011, Eye.

[42]  Ashavini M. Pavaskar,et al.  Spatial and temporal variation of rod photoreceptor reflectance in the human retina , 2011, Biomedical optics express.

[43]  J G Fujimoto,et al.  High-speed, ultra-high-resolution optical coherence tomography of acute macular neuroretinopathy , 2006, British Journal of Ophthalmology.

[44]  David Williams,et al.  Noninvasive imaging of the human rod photoreceptor mosaic using a confocal adaptive optics scanning ophthalmoscope , 2011, Biomedical optics express.

[45]  A. Cideciyan,et al.  Relation of optical coherence tomography to microanatomy in normal and rd chickens. , 1998, Investigative ophthalmology & visual science.

[46]  G. M. Morris,et al.  Images of cone photoreceptors in the living human eye , 1996, Vision Research.

[47]  B. Leroy,et al.  Two cases of acute macular neuroretinopathy , 2007, Eye.