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Bottin, Caroline, MD*; Grieve, Kate, PhD*,†; Rossant, Florence, PhD; Pedinielli, Alexandre, MD§; Mrejen, Sarah, MD*; Paques, Michel, MD, PhD*,†

Retinal Cases and Brief Reports: October 2018 - Volume 12 - Issue - p S19–S24
doi: 10.1097/ICB.0000000000000701
Case Report

Purpose: To document directional reflectivity of fundus lesions in a case of acute macular neuroretinopathy.

Methods: Case report. Clinical and imaging data from a patient with acute macular neuroretinopathy were reviewed. Imaging comprised infrared scanning laser ophthalmoscopy, optical coherence tomography and flood-illumination adaptive optics images acquired through different entry pupils in the cardinal directions (approximately 2° eccentricity).

Results: The patient reported acute bilateral paracentral scotoma revealing dark, wedge-shaped macular plaques which by optical coherence tomography were associated with focal loss of the visibility of the cone outer segment tip and inner/outer segment lines. Comparing scanning laser ophthalmoscopy images taken at different entry points in the pupil showed that macular plaques varied from hyporeflectance to isoreflectance. Cone counts by flood-illumination adaptive optics within plaques and optical coherence tomography features of the cone outer segment tip showed also a strong directional variability, peaking at near-normal values. Within each modality, fusion images showed that directional variability covered most of macular plaques.

Conclusion: The characteristic fundus abnormalities of acute macular neuroretinopathy may show a strong directional variability. Our findings suggest that the Stiles–Crawford effect may be an important factor in signs and symptoms of acute macular neuroretinopathy.

In a case of acute macular neuroretinopathy, significant variability of fundus features were observed using infrared scanning laser ophthalmoscopy images, optical coherence tomography, and adaptive-optics en face images when taking images through different point of entry in the pupil. This suggests that photoreceptors mispointing or disarray may be present in acute macular neuroretinopathy, and hence that the Stiles–Crawford effect contributes to fundus features.

*Ophthalmology Department, Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS Clinical Investigation Center 1423, Paris, France;

Université Pierre et Marie Curie-Paris 6, Paris, France;

Paris Institute of Electronics, Paris, France; and

§Ophthalmology Department, Créteil Hospital, Créteil, France.

Reprint requests: Michel Paques, MD, PhD, Quinze-Vingts Hospital, 28 rue de Charenton, Paris F-75012, France; e-mail:

Supported by the Institut National de la Santé et de la Recherche Médicale (Contrat d'Interface 2011), the Agence Nationale de la Recherche (ANR-09-TECS-009, Recherche Hospitalo-Universitaire Light4Deaf) and the Foundation Fighting Blindness (C-GE-0912-0601-INSERM02). The funding organizations had no role in the design or conduct of this research.

M. Paques and S. Mrejen hold a patent (FR1153306) on multiangle OCT. The remaining authors have no any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.