Acute Macular Neuroretinopathy: Report of A Rare Case

Introduction: 
Acute macular neuroretinopathy (AMN) is a relatively rare condition characterized by central or paracentral scotoma in the presence of a generally good visual acuity. This report aims to highlight the consideration for a diagnosis of acute macular neuroretinopathy in a case of scotoma. 

Methodology: 
Case report. 

Results: 
A 32-year-old Malay lady, presented with incidental finding of right eye central scotoma while procuring new pair of glasses. Visual acuity was 6/6 in both eyes with unremarkable anterior segment findings and normal intraocular pressure. Dilated fundus showed pink optic disc with increased cup-disc ratio of 0.7 and temporal thinning, flat retina and macula, with good foveal reflex. Optical coherence tomography (OCT) of right eye revealed thickened outer plexiform layer (OPL). Brain imaging was normal. Various tests to determine infectious and immunologic etiologies were performed only to reveal unremarkable results. Special ophthalmic imaging to ascertain vascular etiologies were also unexceptional, as they unveiled normal perfusion and flow of the choroid and retinal vessels. Patient was started on a course of oral prednisolone over a period of 2 months, however central scotoma persisted to a minimum, evidently so on Amsler grid chart and Humphrey Visual Field test. 

Discussion/Conclusion: 
Diagnosis of AMN should be considered when dealing with cases presenting with scotoma despite normal looking fundus and neuroimaging findings.

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