ACUTE MACULAR NEURORETINOPATHY-LIKE LESIONS AS AN OCT-DEFINED PHENOTYPE: A SPECTRUM FROM ISCHEMIA TO INFLAMMATION

Purpose: To describe clinical and imaging features of acute macular neuroretinopathy (AMN)-like lesions occurring in association with different ocular diseases. Methods: This retrospective observational case series involved a review of the medical records from a tertiary referral center over 15 years. Seventeen participants (18 eyes), including 11 females and 6 males (mean age 28.9 ± 14.6 years), had ocular diseases complicated by AMN-like lesions. All cases were confirmed using multimodal imaging, including spectral domain optical coherence tomography (OCT) and near-infrared reflectance. Clinical data and lesion morphology were summarized and categorized according to the underlying ocular disease. Results: The associated conditions comprised optic neuritis in 9 eyes, retinal artery occlusion in 3 eyes, and in 1 eye each for Purtscher’s retinopathy, Purtscher-like retinopathy, combined retinal vein and artery occlusion, acute posterior multifocal placoid pigment epitheliopathy, frosted branch angiitis, and multiple evanescent white dot syndrome. AMN-like lesions were more often punctate than wedge-shaped in the eyes with optic neuritis. Vascular occlusion cases frequently demonstrated concurrent wedge shape and paracentral acute middle maculopathy. Eyes with inflammatory disorders showed heterogeneous AMN-like lesions. This case series includes the first reported case of AMN-like lesion secondary to idiopathic frosted branch angiitis and several ocular diseases, otherwise reported rarely. Conclusions: AMN-like lesions occurred in a broad range of ocular diseases. Lesion morphology and imaging features varied with the underlying conditions, supporting these lesions as an OCT phenotype rather than a single entity. Multimodal imaging and clinical context are essential for accurate interpretation.