key: cord-1032245-opvigurr authors: Matri, Khaled El; Werda, Slim; Chebil, Ahmed; Falfoul, Yousra; Hassairi, Asma; Bouraoui, Rim; Matri, Leila El title: Acute macular outer retinopathy as a presumed manifestation of COVID-19 date: 2021-07-08 journal: J Fr Ophtalmol DOI: 10.1016/j.jfo.2021.06.002 sha: 6e104d072b5a3210d6314e359ecf5b34b1cc349a doc_id: 1032245 cord_uid: opvigurr nan We report a case of unilateral AMOR following a SARS-CoV-2 infection, assessed with multimodal imaging. A 75-year-old diabetic female patient was referred to our department for diabetic retinopathy screening. Fundus examination and colour fundus photography (CFP) showed non proliferative DR in both eyes, but we noted the presence of an intermaculopapillary reddishbrown well-limited rectangular lesion in the right eye (RE). It looked like a too well-limited deep retinal hemorrhage (figure 1-A). On infrared imaging (IR), the lesion appeared slightly hypo-reflective (Figure 1 The pathophysiology of AMOR remains unclear but in the era of OCT-A we have valuable data supporting the retinal vascular origin of this rare condition. Some authors suggested DCP ischemia [3] at the origin of the lesion, while others identified flow deficits at the level of the CC [4] . It is most likely that both DCP and CC are incriminated in the disease pathogenesis. Moreover, cross-sectional OCT-A has shown very useful highlighting areas of flow deficit or reduction within different retinal layers and choriocapillaris, as observed in our case [5] . AMOR has been previously linked to viral infections [2] . Besides, since the beginning of COVID-19 epidemic, we observed an increasing number of papers reporting presumed and confirmed ocular manifestations of COVID-19 [6] . Indeed, ocular involvement by COVID19 is no longer refutable and the association of both types of AMN and SARS-CoV-2 infection have been reported in few isolated cases [7] [8] [9] . AMOR might be more frequently associated to COVID-19 than expected, however subjective ocular signs as relative paracentral scotomas might go unnoticed in presence of severe systemic manifestations of COVID-19. Our patient developed ocular symptoms one month following confirmed SARS-CoV-2 infection and diagnosis of AMOR was incidentally made upon a systematic multimodal assessment of a diabetic patient. In our case, AMOR has been presumed as probable manifestation of COVID-19. A larger series of systematic multimodal retinal imaging of patients following COVID-19 is necessary to determine if there is a true association indeed. -Declaration of interest: The authors declare that there is no conflict of interest. showing a normal vascular density in the SCP, a reduced capillary flow adjacent to the lesion territory in the DCP (red arrowheads) and a well-limited area of flow deficit in the CC (red circle). Cross-sectional OCT-A revealing a markedly reduced flow overlay within the hyperreflective lesion (yellow star). Acute macular neuroretinopathy Quantification of retinal layer thickness changes in acute macular neuroretinopathy Acute macular neuroretinopathy: A comprehensive review of the literature Optical Coherence Tomographic Angiography in Acute Macular Neuroretinopathy Projection-Resolved OCT Angiography of Microvascular Changes in Paracentral Acute Middle Maculopathy and Acute Macular Neuroretinopathy Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis Acute macular neuroretinopathy as a manifestation of covid-19 Covid-19-Associated Retinopathy: A Case Report Paracentral acute middle maculopathy and acute macular neuroretinopathy following SARS-CoV-2 infection