Bottin Caroline, Grieve Kate, Rossant Florence, Pedinielli Alexandre, Mrejen Sarah, Paques Michel
Ophthalmology Department, Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS Clinical Investigation Center 1423, Paris, France.
Université Pierre et Marie Curie-Paris 6, Paris, France.
Retin Cases Brief Rep. 2018;12 Suppl 1:S19-S24. doi: 10.1097/ICB.0000000000000701.
To document directional reflectivity of fundus lesions in a case of acute macular neuroretinopathy.
Case report. Clinical and imaging data from a patient with acute macular neuroretinopathy were reviewed. Imaging comprised infrared scanning laser ophthalmoscopy, optical coherence tomography and flood-illumination adaptive optics images acquired through different entry pupils in the cardinal directions (approximately 2° eccentricity).
The patient reported acute bilateral paracentral scotoma revealing dark, wedge-shaped macular plaques which by optical coherence tomography were associated with focal loss of the visibility of the cone outer segment tip and inner/outer segment lines. Comparing scanning laser ophthalmoscopy images taken at different entry points in the pupil showed that macular plaques varied from hyporeflectance to isoreflectance. Cone counts by flood-illumination adaptive optics within plaques and optical coherence tomography features of the cone outer segment tip showed also a strong directional variability, peaking at near-normal values. Within each modality, fusion images showed that directional variability covered most of macular plaques.
The characteristic fundus abnormalities of acute macular neuroretinopathy may show a strong directional variability. Our findings suggest that the Stiles-Crawford effect may be an important factor in signs and symptoms of acute macular neuroretinopathy.
记录一例急性黄斑神经视网膜病变患者眼底病变的方向反射率。
病例报告。回顾了一名急性黄斑神经视网膜病变患者的临床和影像学资料。影像学检查包括红外扫描激光检眼镜检查、光学相干断层扫描以及通过不同主方向（约2°偏心率）的入瞳获取的泛光照明自适应光学图像。
患者报告双侧急性旁中心暗点，眼底可见深色楔形黄斑斑片，光学相干断层扫描显示这些斑片与视锥细胞外段尖端及内/外段线的局灶性可见性丧失有关。比较在瞳孔不同入瞳点拍摄的扫描激光检眼镜图像发现，黄斑斑片的反射率从低反射到等反射不等。泛光照明自适应光学检查在斑片内的视锥细胞计数以及视锥细胞外段尖端的光学相干断层扫描特征也显示出强烈的方向变异性，峰值接近正常值。在每种检查方式中，融合图像显示方向变异性覆盖了大部分黄斑斑片。
急性黄斑神经视网膜病变的特征性眼底异常可能表现出强烈的方向变异性。我们的研究结果表明，斯泰尔斯-克劳福德效应可能是急性黄斑神经视网膜病变体征和症状的一个重要因素。
