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      C-Shaped Scotoma after Complicated Cesarean Section: A Case of Acute Macular Neuroretinopathy

      case-report

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          Abstract

          Acute macular neuroretinopathy (AMN) is a rare retinal disease that produces transient or permanent visual impairment and occurs predominantly in young, Caucasian women of childbearing age. It is often characterized by wedge-like macular lesions. Although the cause of AMN is unknown, recent research suggests a microvascular etiology. Various vascular pathologies, including post-viral illness, oral contraceptives, and use of vasoconstrictive agents, have been associated with AMN. We present a case of a woman with C-shaped visual field defects in both eyes after inadvertent exposure to intravenous high-dose epinephrine during onset of spinal anesthesia. At present, only 8 cases of AMN after exposure to epinephrine have been described in literature. To our knowledge, this is the first case of AMN that presented following epinephrine injection during childbirth.

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          Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia.

          Ehsan Rahimy, John Sorenson, Amani A Fawzi … (2013)
          With the advent of more sophisticated imaging systems, such as spectral domain optical coherence tomography (SD-OCT), disruption of the inner segment/outer segment (IS/OS) band, and thinning of the outer nuclear layer (ONL) have been identified in association with acute macular neuroretinopathy (AMN). To characterize a new SD-OCT presentation of AMN as a paracentral acute middle maculopathy and to describe multimodal imaging findings that implicate an underlying pathogenesis related to retinal capillary ischemia. Retrospective observational case series (January 1, 2012, to January 1, 2013) reviewing clinical and imaging data from 9 patients (11 eyes) with AMN at 6 tertiary referral centers. Lesions were classified as type 1 or 2 in relation to the SD-OCT location of the lesion above (type 1) or below (type 2) the outer plexiform layer (OPL) at 6 tertiary referral centers. Of the 9 patients, 5 were female and 4 were male (mean age, 47.6 years; range, 21-65 years). All patients presented with an acute paracentral scotoma and demonstrated a classic dark gray paracentral lesion with near-infrared imaging. Visual acuity ranged from 20/15 to 20/30. Six eyes (5 patients) had type 1 SD-OCT lesions, also referred to as paracentral acute middle maculopathy, and 5 eyes (4 patients) had type 2 SD-OCT lesions. Although type 1 lesions lead to inner nuclear layer (INL) thinning, type 2 lesions resulted in ONL thinning. Type 2 lesions were always associated with significant outer macular defects, including disruption of the inner segment/outer segment and outer segment/retinal pigment epithelium bands, whereas type 1 lesions spared the outer macula. Paracentral acute middle maculopathy may represent a novel variant of AMN that affects the middle layers of the macula above the OPL as diagnosed with SD-OCT imaging. Two types of AMN lesions may be seen with SD-OCT occurring above and below the OPL. Type 1 refers to hyperreflective bands in the OPL/INL region with subsequent INL thinning. Type 2 is hyperreflective bands in the OPL/ONL region with subsequent ONL thinning. Type 2 lesions may be associated with concomitant defects of the inner segment/outer segment layer. We propose that each of these lesions may be explained by occlusion of either the superficial capillary plexus (type 1) or deep capillary plexus (type 2) located in the innermost and outermost portion of the INL, respectively, immediately adjacent to each corresponding lesion type.
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            Acute macular neuroretinopathy: A comprehensive review of the literature.

            Emmett Cunningham, Kavita V Bhavsar, Sally Y. Lin … (2016)
            Acute macular neuroretinopathy is a relatively rare condition originally defined by the presence of intraretinal, reddish-brown, wedge-shaped lesions, the apices of which tend to point toward the fovea. Acute onset of paracentral scotomas corresponding to the clinically evident lesions is both common and characteristic. Although the pathogenesis of acute macular neuroretinopathy is complex, recent research suggests a microvascular etiology. Advances in multimodal imaging have enabled better characterization of this retinal disorder and have led to newly proposed diagnostic criteria. We review 101 reported cases in the English and non-English language literature identified from 1975, when acute macular neuroretinopathy was first described, to December, 2014. We discuss common risk factors, demographic and clinical characteristics, and multimodal imaging findings, which together provide insights into pathogenesis and guide areas of future investigation.
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              Deep Retinal Capillary Nonperfusion Is Associated With Photoreceptor Disruption in Diabetic Macular Ischemia.

              FABIO SCARINCI, PETER L. NESPER, AMANI A. FAWZI (2016)
              To report outer retinal structural changes associated with macular capillary nonperfusion at the level of deep capillary plexus (DCP) in diabetic patients.
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                Author and article information

                Journal
                Journal ID (publisher-id): COP
                Journal ID (pmc): COP
                Journal ID (doi): 10.1159/issn.1663-2699
                Title: Case Reports in Ophthalmology
                Publisher: S. Karger AG
                ISSN (Electronic): 1663-2699
                Publication date Subscription-year: 2019
                Publication date Collection: September - December 2019
                Publication date (Electronic): 26 November 2019
                Volume: 10
                Issue: 3
                Pages: 391-396
                Affiliations
                [_a] aDepartment of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
                [_b] bDepartment of Anesthesiology and Intensive Care, Medical University Innsbruck, Innsbruck, Austria
                Author notes
                *Claus Zehetner, MD, Department of Ophthalmology and Optometry, Medical University of Innsbruck, Anichstrasse 35, AT–6020 Innsbruck (Austria), E-Mail claus.zehetner@i-med.ac.at
                Article
                Publisher ID: 504289 Pmcid ID: PMC6940446 Other ID: Case Rep Ophthalmol 2019;10:391–396
                DOI: 10.1159/000504289
                PMC ID: PMC6940446
                PubMed ID: 31911780
                SO-VID: 94b48a8e-55df-4f2d-b81b-eaedfac7cc7d
                Copyright © © 2019 The Author(s). Published by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 07 August 2019
                Date accepted : 20 October 2019
                Page count
                Figures: 2, Pages: 6
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Epinephrine,Acute macular neuroretinopathy,Cesarean section,Retinal microvasculature ,Spectral-domain optical coherence tomography
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Epinephrine, Acute macular neuroretinopathy, Cesarean section, Retinal microvasculature , Spectral-domain optical coherence tomography

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