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Acute Macular Neuroretinopathy Related to Alcoholic Hepatitis

Authors
  • Mc Cabe, Grace Anne
  • Campbell, William Gordon
  • Campbell, Thomas Gordon
Type
Published Article
Journal
Case Reports in Ophthalmology
Publisher
S. Karger AG
Publication Date
Apr 30, 2021
Volume
12
Issue
1
Pages
293–298
Identifiers
DOI: 10.1159/000513186
Source
Karger
Keywords
License
Green
External links

Abstract

A 33-year-old woman admitted for acute alcoholic hepatitis was referred to the ophthalmology department with an acute onset paracentral scotoma of the left eye. On examination, best-corrected visual acuity was Snellen 6/4 in the right eye and 6/9 in the left eye. Dilated left fundus examination revealed wedge-shaped changes at the macula. Spectral-domain ocular coherence tomography (SD-OCT) initially revealed a small cuff of subfoveal fluid and band-like hyperreflectivity extending outwards from the outer plexiform layer consistent with acute macular neuroretinopathy (AMN). Four days later, repeat SD-OCT was performed and it demonstrated resolution of the subfoveal fluid and disruption of the outer retinal layers. At the 6-week follow-up, the patient had no improvement in her symptoms and OCT angiography demonstrated coarsening and microvascular changes in both the deep vascular plexus and the choriocapillaris. To our knowledge, this is the first case of AMN in association with acute hepatitis. Although the exact pathophysiology of AMN remains obscure, this case highlights the benefits of multimodal retinal imaging and aims to bring attention to the possible association of AMN with alcoholic hepatitis.

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