Infrared imaging and spectral-domain optical coherence tomography findings correlate with microperimetry in acute macula...

MISSING IMAGE

Material Information

Title:
Infrared imaging and spectral-domain optical coherence tomography findings correlate with microperimetry in acute macular neuroretinopathy : a case report
Series Title:
Journal of Medical Case Reports
Physical Description:
Mixed Material
Language:
English
Creator:
Grover, Sandeep
Brar, Vikram S.
Murthy, Ravi K.
Chalam, Kakarla
Publisher:
BioMed Central
Publication Date:

Notes

Abstract:
Introduction: Spectral-domain optical coherence tomography findings in a patient with acute macular neuroretinopathy, and correlation with functional defects on microperimetry, are presented. Case presentation: A 25-year old Caucasian woman presented with bitemporal field defects following an upper respiratory tract infection. Her visual acuity was 20/20 in both eyes and a dilated fundus examination revealed bilateral hyperpigmentary changes in the papillomacular bundle. Our patient underwent further evaluation with spectral-domain optical coherence tomography, infrared and fundus autofluorescence imaging. Functional changes were assessed by microperimetry. Infrared imaging showed the classic wedge-shaped defects and spectral-domain optical coherence tomography exhibited changes at the inner segment-outer segment junction, with a thickened outer plexiform layer overlying these areas. Fluorescein and indocyanine green angiography did not demonstrate any perfusion defects or any other abnormality. Microperimetry demonstrated focal elevation in threshold correlating with the wedge-shaped defects in both eyes. Conclusion: Spectral-domain optical coherence tomography findings provide new evidence of the involvement of the outer plexiform layer of the retina in acute macular neuroretinopathy.
General Note:
Publication of this article was funded in part by the University of Florida Open-Access publishing Fund. In addition, requestors receiving funding through the UFOAP project are expected to submit a post-review, final draft of the article to UF's institutional repository, IR@UF, (www.uflib.ufl.edu/ufir) at the time of funding. The Institutional Repository at the University of Florida (IR@UF) is the digital archive for the intellectual output of the University of Florida community, with research, news, outreach and educational materials

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
All rights reserved by the source institution.
Resource Identifier:
doi - 10.1186-1752-1947-5-536
System ID:
AA00008943:00001


This item is only available as the following downloads:


Full Text

PAGE 1

CASEREPORT OpenAccessInfraredimagingandspectral-domainoptical coherencetomographyfindingscorrelatewith microperimetryinacutemacular neuroretinopathy:acasereportSandeepGrover*,VikramSBrar,RaviKMurthyandKakarlaVChalamAbstractIntroduction: Spectral-domainopticalcoherencetomographyfindingsinapatientwithacutemacular neuroretinopathy,andcorrelationwithfunctionaldefectsonmicroperimetry,arepresented. Casepresentation: A25-yearoldCaucasianwomanpresentedwithbitemporalfielddefectsfollowinganupper respiratorytractinfection.Hervisualacuitywas20/20inbotheyesandadilatedfundusexaminationrevealed bilateralhyperpigmentarychangesinthepapillomacularbundle.Ourpatientunderwentfurtherevaluationwith spectral-domainopticalcoherencetomography,infraredandfundusautofluorescenceimaging.Functionalchanges wereassessedbymicroperimetry.Infraredimagingshowedtheclassicwedge-shapeddefectsandspectral-domain opticalcoherencetomographyexhibitedchangesattheinnersegment-outersegmentjunction,withathickened outerplexiformlayeroverlyingtheseareas.Fluoresceinandindocyaninegreenangiographydidnotdemonstrate anyperfusiondefectsoranyotherabnormality.Microperimetrydemonstratedfocalelevationinthreshold correlatingwiththewedge-shapeddefectsinbotheyes. Conclusion: Spectral-domainopticalcoherencetomographyfindingsprovidenewevidenceoftheinvolvementof theouterplexiformlayeroftheretinainacutemacularneuroretinopathy.IntroductionAcutemacularneuroretinopathy(AMNR)isarareconditioncharacterizedbywedg e-shapedlesionspointing towardsthefovealcenter,resultinginbilateralorunilateralscotomas,typicallywithpreservedcentralvisual acuities[1,2].Theassociationofthisconditionwithoral contraceptive(OCP)useandintravenoussympathomimeticadministrationsuggestsavascularetiology, althoughangiographyhasco nsistentlyfailedtodemonstrateaperfusiondefect[2].Findingsontimedomain opticalcoherencetomography(OCT)indicatethatthe pathologyislocatedintheouterretina[3]. Wepresentfindingsofinfrared(IR)imagingandspectral-domainOCT(SD-OCT;Spectralis,Heidelberg,Germany)andcorrelatethesewithretinalfunctionby microperimetry.Thefindin gsdemonstrateouterplexiformlayer(OPL)thickeninginthiscaseofAMNR.CasepresentationA25year-oldCaucasianwomanpresentedwithafourdayhistoryofacuteonsetofblurredvisioninbotheyes. Shereportedaviralupperrespiratorytractinfectionfor sevento10days,forwhichshehadtakentwoExcedrinMigraine(acetaminophen250mg,aspirin250mg andcaffeine65mg)tablets.SheusedMidrin(acetaminophen325mg,dichloralphenazone100mg,isometheptenemucate65mg)asneededforherheadaches concurrently.Additionally,shesmokedhalf-packcigarettesandconsumedfourtofive12-ouncecansofacaffeinateddrink,MountainDew(caffeine54mg/can)per day. HeruncorrectedSnellenvisualacuitywas20/20in botheyesandAmslertestingrevealedbitemporalparacentralscotomas.Shecorrectlyidentified10andnine *Correspondence:sgrover@jax.ufl.edu DepartmentofOphthalmology,UniversityofFloridaCollegeofMedicine, Jacksonville,Florida,USAGrover etal JournalofMedicalCaseReports 2011, 5 :536 http://www.jmedicalcasereports.com/content/5/1/536 JOURNAL OF MEDICALCASE REPORTS 2011Groveretal;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommons AttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproductionin anymedium,providedtheoriginalworkisproperlycited.

PAGE 2

outof14Ishiharacolorplates,inherrightandlefteye, respectively.Noafferentpupillarydefectwasnotedand theanteriorsegmentwasunremarkable.Fundusexaminationrevealedbilateralhyperpigmentarychangesinthe papillomacularbundle(Figure1A).Fundus autofluorescencerevealedanormalautofluorescence pattern.IRimagingdisclosedclassicwedge-shaped lesionswiththeirapicesorientedtowardsthefovea.SDOCTexhibitedchangesattheinnersegment-outersegment(IS-OS)junction,withathickenedOPLoverlying Figure1 Colorfundusphotographs .(Toppanel)Imagesoftherightandlefteyerevealsubtleirregularitiesoftheinternallimitingmembrane reflexandpigmentarychanges.IRimagingwithcorrespondingSpectralisOCTcross-sectionalimageoftheright(Middlepanel)andleft (Bottompanel)eyerevealsclassicwedge-shapedlesions.SpectralisOCTdemonstratesthickeningoftheOPLwithunderlyingthinningofthe outernuclearlayer.TheIS-OSlineisaffectedinbotheyes. Grover etal JournalofMedicalCaseReports 2011, 5 :536 http://www.jmedicalcasereports.com/content/5/1/536 Page2of4

PAGE 3

theseareas(Figures1B,C).Humphreyvisualfield (HVF)30-2demonstratedbilateralparacentralscotomas. Fluoresceinandindocyaninegreenangiographydidnot demonstrateanyperfusiondefectsoranyother abnormality. Fivemonthsafterinitialpresentation,hercolorvision improvedto14of14Ishiharacolorplatescorrectly identifiedineacheye.RepeatHVFtestingdemonstrated intervalimprovementinthescotomas,moreinherright eyethanleft.Similarly,SD -OCTshowedacorrespondingsmallimprovementattheIS-OSjunctioninher righteye(Figure2Aand2B)andnochangeinherleft eye(Figure2Cand2D).MicroperimetryusinganMP-1 (Nidek,Japan)demonstratedfocalelevationinthreshold correlatingwiththewedge-shapeddefectsinbothher eyes(Figure2Eand2F).ConclusionAMNRremainsanelusiveconditioninregardstothe etiologyofretinallesions. Eighty-threepercentofcases affectyoungerwomen,nearlyhalfofwhomreportan associatedviralillness[1].Otherreportedassociations includeOCPuseandtheintravenousadministrationof epinephrine(rangingfrom0.5mLina1:1000solution to10mg)andephedrine(25mg)[2].Ourpatientwas nottakingOCPandreportsoraldecongestantuseonly. Shedidreportconsumingcaffeineofupto270mgper day,whichisfarlessthanthatreportedincasesof caffeine-doughnutmaculopathy [4]. Inourpatient,thecharacteristiclesionswerenotseen onfundusexamination,butwereclearlyevidentonIR imaging.Fundusautofluorescencedidnotdemonstrate anabnormalautofluorescencepattern,indicatingthat theretinalpigmentepitheliumwasnotaffected.Two recentreportsdemonstratedlocalizationoftheretinal lesionsinAMNRtothephotoreceptorIS/OSjunction, usingultra-highresolutionOCT[5,6].SD-OCTfindings inourpatientconfirmedthesefindingsbutadditionally, wenotedfocalthickeningoftheOPLoverlyingthese lesions.Microperimetrydemonstratedthepresenceof Figure2 SequentialSpectralisOCTimages .Therighteyeat (A) thetimeofinitialpresentationand (B) fivemonthslatershowingsmall improvementintheIS-OSjunction.Thelefteyeat (C) thetimeofpresentationand (D) fivemonthslaterdidnotshowanyimprovement. (E andF) Microperimetrydemonstratedelevationinthresholdintheareaofthelesioninbotheyes(righteye,Eandlefteye,F). Grover etal JournalofMedicalCaseReports 2011, 5 :536 http://www.jmedicalcasereports.com/content/5/1/536 Page3of4

PAGE 4

elevatedthresholdcorrespondingtotheareaofOPL thickening.ThepresenceofOPLinvolvementconfirms thediseaseprocesstotheouterretina.ConsentWritteninformedconsentwasobtainedfromthepatient forpublicationofthiscasereportandanyaccompanyingimages.Acopyofthewrittenconsentisavailable forreviewbytheEditor-in-Chiefofthisjournal.Authors contributions VBandSGwereresponsiblefortheclinicalfollow-upofourpatient.RM,SG andKCwereresponsibleforeditingandcriticalreviewofthemanuscript. Allauthorshavereadandapprovedthefinalmanuscript. Competinginterests Theauthorsdeclarethattheyhavenocompetinginterests. Received:23April2011Accepted:31October2011 Published:31October2011 References1.BosPJ,DeutmanAF: Acutemacularneuroretinopathy. AmJOphthalmol 1975, 80(4) :573-584. 2.TurbevilleSD,CowanLD,GassJD: Acutemacularneuroretinopathy:a reviewoftheliterature. SurvOphthalmol 2003, 48(1) :1-11. 3.FeiglB,HaasA: Opticalcoherencetomography(OCT)inacutemacular neuroretinopathy. ActaOphthalmolScand 2000, 78(6) :714-716. 4.KerrisonJB,PollockSC,BiousseV,NewmanNJ: Coffeeanddoughnut maculopathy:acauseofacutecentralringscotomas. BrJOphthalmol 2000, 84(2) :158-164. 5.MonsonBK,GreenbergPB,GreenbergE,FujimotoJG,SrinivasanVJ, DukerJS: High-speed,ultra-high-resolutionopticalcoherence tomographyofacutemacularneuroretinopathy. BrJOphthalmol 2007, 91(1) :119-120. 6.HughesEH,SiowYC,HunyorAP: Acutemacularneuroretinopathy: anatomiclocalisationofthelesionwithhigh-resolutionOCT. Eye(Lond) 2009, 23(11) :2132-2134.doi:10.1186/1752-1947-5-536 Citethisarticleas: Grover etal .: Infraredimagingandspectral-domain opticalcoherencetomographyfindingscorrelatewithmicroperimetry inacutemacularneuroretinopathy:acasereport. JournalofMedicalCase Reports 2011 5 :536. Submit your next manuscript to BioMed Central and take full advantage of: Convenient online submission Thorough peer review No space constraints or color gure charges Immediate publication on acceptance Inclusion in PubMed, CAS, Scopus and Google Scholar Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Grover etal JournalofMedicalCaseReports 2011, 5 :536 http://www.jmedicalcasereports.com/content/5/1/536 Page4of4