Pang Claudine E, Navajas Eduardo V, Warner Simon J, Heisler Morgan, Sarunic Marinko V
Ophthalmic Surg Lasers Imaging Retina. 2016 Jun 1;47(6):596-9. doi: 10.3928/23258160-20160601-15.
A 47-year-old man with recent travel to the Caribbean was admitted with acute febrileillness associated with arthralgia and skin rash followed by sudden onset of bilateral visual field defects. Funduscopy revealed subtle bilateral paracentral dark lesions nasal to the fovea best seen on near infrared imaging as hyporeflective, wedge-shaped, paracentral macular lesions. Spectral-domain optical coherence tomography (SD-OCT) through the lesions revealed hyperreflective bands at the level of the outer plexiform layer and outer nuclear layer (ONL), with concomitant attenuation of the underlying external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). Neither fluorescein angiography nor speckle variance OCT angiography (sv-OCTA) showed any defects in retinal circulation. Work up revealed positive Immunoglobulin M for Chikungunya virus (CHIKV). Six months later, the patient had persistent scotomas, although reduced in size. SD-OCT showed subtle ONL thinning and restoration of the ELM, although EZ and IZ remained disrupted. Chikungunya fever may manifest as bilateral acute macular neuroretinopathy (AMN). Clinicians should be aware of possible systemic associations of AMN. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:596-599.].
一名近期前往加勒比地区旅行的47岁男性因急性发热性疾病入院，该疾病伴有关节痛和皮疹，随后突然出现双侧视野缺损。眼底检查发现双侧黄斑中心凹鼻侧有细微的旁中心暗病变，在近红外成像中最易见，表现为低反射、楔形的旁中心黄斑病变。通过病变部位的光谱域光学相干断层扫描（SD-OCT）显示在外丛状层和外核层（ONL）水平有高反射带，同时其下方的外界膜（ELM）、椭圆体带（EZ）和指状交叉带（IZ）衰减。荧光素血管造影和斑点方差OCT血管造影（sv-OCTA）均未显示视网膜循环有任何缺陷。检查发现基孔肯雅病毒（CHIKV）免疫球蛋白M呈阳性。六个月后，患者仍有持续性暗点，尽管尺寸有所减小。SD-OCT显示ONL有细微变薄，ELM恢复，尽管EZ和IZ仍有破坏。基孔肯雅热可能表现为双侧急性黄斑神经视网膜病变（AMN）。临床医生应意识到AMN可能存在的全身关联。[《眼科手术、激光与视网膜成像》。2016年；47:596 - 599。]
