Table 1.
Identified cases of acute macular neuroretinopathy after COVID-19 vaccination in the literature.
| Case No./Author | Age/sex | Vaccine | Drug history/background illness | Interval (days) | Presenting symptoms | Imaging features | Outcome |
|---|---|---|---|---|---|---|---|
| #1 Fekri et al. | 18/F | BBIBP-CorV [Sinopharm] | Unremarkable | 5 | Bilateral paracentral scotomas | IR: wedge-shaped (OD) and diffuse semi-circular (OS) perifoveal lesions | Subjective resolution of visual defects and partial improvement of lesions on OCT and IR images at 2 weeks follow-up |
| OCT: OPL thickening – ONL thinning – EZ disruption | |||||||
| #2 Book et al. [31] | 21/F | AZD1222 [AstraZeneca] | OCP/– | 3 | Bilateral paracentral scotomas | IR: Bilateral confined paracentral lesions | NR |
| OCT: OPL thickening – EZ disruption | |||||||
| #3 Drüke et al. [17] | 23/F | AZD1222 [AstraZeneca] | OCP, steroids/JIA & recurrent iritis | 1 | Bilateral paracentral scotomas | IR: Bilateral confined parafoeveal lesions | Despite initial improvement, scotomas persisted with slow regression of lesion (in 15 weeks) |
| OCT: OPL thickening – ONL thinning – Disruption of EZ, IZ, and ELM | |||||||
| #4 Girbardt et al. [25] | 21/F | AZD1222 [AstraZeneca] | – | 3 | Paracentral scotoma (OS) | IR: Bilateral confined paracentral lesions | NR |
| OCT: subtle outer retinal alterations, more pronounced in the left eye | |||||||
| #5 Mambretti et al. [16] | 22/F | AZD1222 [AstraZeneca] | OCP/– | 2 | Scotoma (OD) | IR: Tear drop-shaped perifoveal lesions | NR |
| OCT: hyperreflectivity of OPL and ONL – EZ disruption | |||||||
| #6 Mambretti et al. [16] | 28/F | AZD1222 [AstraZeneca] | OCP/– | 2 | Paracentral scotoma (OD) | IR: wedge-shaped lesion in papillo-macular bundle | NR |
| OCT: hyperreflectivity of OPL and ONL – EZ attenuation | |||||||
| #7 Pichi et al. [18] | NR | BBIBP-CorV [Sinopharm] | CSCR (OU)–chronic serous PED (OS)–Choroidal thickness | 5 | Acute vision loss (OS) | OCT: hyperreflectivity of OPL, HFL, and ONL – EZ attenuation | BCVA improvement & resolution of OCT findings (at 2 months follow-up) |
| OCTA: Semilunar area of signal absence at DCP | |||||||
| #8/Valenzuela et al. [26] | 20/F | BNT162b2 [Pfizer-BioNTech] | CVR/– | 2 | Photopsia and bilateral scotomas | OCT: parafoveal hyperreflective foci at ONL–EZ granularity | Complete resolution of scotomas (at 1 week follow-up) |
| #9 Bøhler et al. [29] | 27/F | AZD1222 [AstraZeneca] | OCP/– | 2 | Paracentral scotoma (OS) | OCT: Teardrop-shaped macular lesion (en face view)/hyperreflectivity of OPL and ONL – EZ disruption (cross-sectional view) | NR |
| #10 Chen et al. [32] | 21/F | BNT162b2 [Pfizer-BioNTech] | OCP/– | 3 | Paracentral scotoma (OS) | IR: 2 parafoeval oval hyporeflective lesions (OS) | Gradual reduction of scotoma intensity over 10 weeks |
| OCT: focal areas of paracentral OPL and ONL hyperreflectivity – EZ disruption | |||||||
| #11 Diafas et al. [19] | 54/M | BNT162b2 [Pfizer-BioNTech] | NR/T2DM, low myopia | 21 | Photopsia and small scotoma (OS) | OCT: OPL hyperreflective band – EZ disruption | Remained symptomatic at 2 months follow-up |
| #12 Franchi et al. [20] | 19/F | AZD1222 [AstraZeneca] | OCP (DC 2 months before presentation)/asthma | 1 | fortification (OS) | NIR: multiple wedge-shaped hyporeflective lesions (OU) | Persisting visual symptoms and photoreceptor layer derangement, despite resolution of hyperreflective bands, at 8 weeks follow-up |
| OCT: parafoveal OPL & ONL hyperreflective bands – EZ disruption (OU) | |||||||
| #13 Franchi et al. [20] | 31/F | AZD1222 [AstraZeneca] | OCP/– | 2 | fortification and paracentral scotoma (OD) | NIR: small wedge-shaped hyporeflective lesions (OU) | Persisting visual symptoms and photoreceptor layer derangement, despite resolution of hyperreflective bands, at 15 weeks follow-up |
| OCT: OPL & ONL hyperreflective bands – EZ disruption (OU) | |||||||
| #14 Gabrielle et al. [33] | 25/F | AZD1222 [AstraZeneca] | OCP/– | 1 | Bilateral paracentral scotomas | NIR: multiple hyporeflective, wedge-shaped, parafoveal lesions | NR |
| OCT: OPL hyperreflectivity and thickening – ONL thinning – Disruption of EZ | |||||||
| #15 Michel et al. [34] | 21/F | AZD1222 [AstraZeneca] | OCP/– | 2 | 4 central scotomas (OS) | NIR: multiple hyporeflective, oval-shaped lesions around the fovea (OS) | Improvement of symptoms, visual field, and OCT biomarkers at 6 weeks follow-up |
| OCT: foci of OPL and ONL hyperreflectivity – ONL thinning – EZ disruption | |||||||
| #16 Ishibashi et al. [21] | 33/F | BNT162b2 [Pfizer-BioNTech] | NR/HTN, Alport syndrome, ESRD | 8 | Visual field defect (OS) | OCT: hyperreflective foci of OPL and ONL – EZ disruption OCTA: signal absence at DCP in the corresponding area |
NR |
| #17 Patel et al. [35] | 26/F | Ad26.COV2.S [Janssen] | OCP/– | 2 | Bilateral paracentral scotomas | NIR: wedge-shaped parafoveal lesions (OS) | NR |
| OCT: parafoveal hyperreflective bands w/o retinal thickening (OU) | |||||||
| #18 Priluck et al. [22] | 20/F | mRNA-1273 [Moderna] | OCP, fluticasone, loratadine/allergic rhinitis, myopia | 8 | Bilateral central scotomas | NIR: hyporeflective wedge-shaped lesions (OU) | Progressive subjective improvement of scotomas w/o complete resolution |
| OCT: EZ disruption at corresponding lesion locations | |||||||
| #19 Sanjay et al. [23] | 25/F | AZD1222 [AstraZeneca] | -/β thalassemia trait | 3 | Blurry vision and Shadow (OD) – one week later, a new scotoma was noticed | NIR: normal | Resolution of AMN (OD) and development of Similar symptoms and findings (OS) a month later |
| OCT: hyperreflective area at OPL and ONL | |||||||
| #20 Zaheer et al. [36] | 22/F | AZD1222 [AstraZeneca] | NA | < 7 | NA | NA | NA |
| #21 Jalink et al. [24] | 42/F | mRNA-1273 [Moderna] | OCP/- | NAa | Barely noticeable scotoma, temporal to the center (OS) | OCT: subtle changes of the ONL and photoreceptor layers | Scotoma was still present but had diminished in size (at 1-month follow-up) |
AMN: acute macular neuroretinopathy; BCVA: best-corrected visual acuity; CSCR: central serous chorioretinopathy; CVR: contraceptive vaginal ring; DC: discontinued; DCP: deep capillary plexus; ELM: external limiting membrane; ESRD: end-stage renal disease; EZ: ellipsoid zone; F: female; HFL: Henle fiber layer; HTN: hypertension; IR: infrared reflectance; IZ: interdigitation zone; JIA: juvenile idiopathic arthritis; M: male; NA: not available; NIR: near-infrared reflectance; NR: not reported; OCP: oral contraceptive pills; OCT: optical coherence tomography; OCTA: optical coherence tomography angiography; OD: oculus dexter; ONL: outer nuclear layer; OPL: outer plexiform layer; OS: oculus sinister; OU: oculus uterque; PED: pigment epithelial detachment; T2DM: type 2 diabetes mellitus.
a
The exact time of symptom onset was unclear, but the time from her last vaccine dose to realizing her visual field defect was ∼ 45 days; her scotoma was hard to perceive and would be noticed only when she closed her right eye.