Acute macular neuroretinopathy as presentation of ocular concussion result in combat injury

    Abstract

    E.K. Gladysheva

    Acute macular neuroretinopathy as presentation of ocular concussion result in combat injury

    S.M. Kirov Military Medical Academy

    Purpose. To analyze the prevalence and clinical significance of acute macular neuroretinopathy (AMN) as presentation of ocular concussion result in combat injury using multimodal imaging.

     Material and methods. 154 patients with closed globe injury and 167 patients with open globe injury were examined. Patients with clinical manifestations of AMN as a result of combat globe injury were selected for analysis. The area of AMN in the macular zone was assessed by analyzing en-face OCT images, as well as structural changes of retinal layers on cross-sectional OCT scans. The presence of concomitant traumatic contusion manifestations was also analyzed. OCT, OCT angiography, fundus photoautofluorescence, and confocal laser ophthalmoscopy of the retina were used for multimodal visualization.

    Results. 10 eyes of patients with closed eye trauma (10 men, average age 29 ± 4 years) with signs of AMN and 1 eye of a patient (man, 48 years) who received an open globe injury with clinical manifestations of AMN were identified. AMN was detected in 2 cases as the only component of concussion injury, in 9 cases AMN was manifestation of concussion injury on the retina. Cumulative distribution of AMN foci showed the tendency of AMN areas to localize mainly within the nasal sector of the macula, with an average value of area of 2.3 ± 1.35 mm2. Patients with AMN made up 6.5% of closed trauma and 0.6% of open globe trauma.

    Conclusion. The prevalence of AMN as one of typical manifestation of concussion result in combat injury made up 6.5% of closed trauma and 0.6% of open globe trauma. The combination of AMN with other manifestations of closed and open globe injury can be explained by the syndromic nature of this phenomenon. AMN can cause persistent visual changes as paracentral and central scotomas, and explain “unexplained scotomas” and “unexplained decreased vision” in patients with ocular trauma. Diagnosis of AMN requires the use of OCT even in situations where there are no ophthalmoscopic changes in the center of the macula.

    Keywords: closed globe trauma; acute macular neuroretinopathy; combat trauma; traumatic maculopathy; optical coherence tomography; optical coherence tomography angiography