LAUSR

Purpose Acute Macular Neuroretinopathy (AMN) is a rare retinal disease distinguished in two different types. In type 1 the lesion occurs above the outer plexiform layer (OPL) interesting the inner nuclear layer (INL), differently in type 2 the lesion occurs below the OPL interesting the outer nuclear layer (ONL). Type 1 is more common among elderly, males, and associated with cardiovascular risk factors while type 2 is more usual in young and females. Methods A 68 years-old white man presented to Ophthalmic Emergency Room complaining the acute-onset of a paracentral superonasal scotoma in his left eye. His medical history was significant for systemic arterial hypertension in good control with diuretics and sartans. He also refers primary open angle glaucoma in treatment with prostaglandin analogous in both eyes. We performed fluorescein and indocyanine green angiographies, spectral domain-Optical Coherence Tomography (SD-OCT), OCT angiography (OCTA), standard automated perimetry (SAP), microperimetry, and multifocal electroretinogram (mfERG). Results Fluorescein and indocyanine green angiographies were unremarkable. SD-OCT revealed a focal hyperreflective band that involved the OPL and ONL localized in the parafoveal inferior region. The SAP showed a superonasal scotoma that was confirmed by the mfERG trace decrease and the inferotemporal reduced retinal sensibility at microperimetry. OCTA revealed a deep retinal capillary plexus perfusion defect area inferotemporally to the fovea. Conclusions Our case describes an unusual AMN type 2 that occurs in an elderly male patient affected by systemic arterial hypertension typical for type 1. These evidences suggest a closer pathogenic relationship between the two forms of AMN. Further studies will be able to determine whether AMN type 1 and AMN type 2 rapresent single or multiple entities.