Acute macular neuroretinopathy in combat closed globe injury of posterior eye segment

Purpose: to analyze the prevalence and clinical significance of acute macular neuroretinopathy (AMN) in combat closed globe trauma using multimodal imaging.

Material and methods. In total, 154 eyes of 136 patienys with combat closed globe trauma of the posterior segment received standard ophthalmological examination and optical coherence tomography (OCT) and OCT angiography. Patients with AMN were identified and selected for analysis. Structural changes of the retina on cross-sectional scans, as well as the area of AMN lesions were analyzed on structural en-face projections.

Results. AMN characterized by thinning of the outer retina was detected in ten eyes of ten patients (10 males, mean age 29 ± 4 years), thus accounting for 6.5 % of cases from all examined eyes with closed eyeball trauma. The analysis of the cumulative distribution showed a trend towards localization of the AMN lesions mainly in the nasal sector of the macula with an average area of 2.4 ± 1.4 mm2. AMN was an isolated manifestation of injury only in two cases, in eight eyes it was combined with other injuries associated with closed eyeball trauma.

Conclusion. AMN is one of the typical lesions in closed eye injury, with a prevalence of 6.5 % among these cases. AMN can cause persistent visual deterioration, including paracentral and central scotomas and may explain “unexplained scotomas” and “unexplained decrease of vision” in patients with mild injury. The contribution of AMN to the structure of closed globe injury agrees with the concept of the syndromic nature of this phenomenon. Diagnosis of AMN requires OCT examination even in cases without ophthalmoscopically detectable changes in the macula.

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