title: New associations of classic acute macular neuroretinopathy.
abstract: OBJECTIVE
  To describe novel underlying associations of classic acute macular neuroretinopathy (AMN).
  
  
  METHODS
  Multimodal imaging case series evaluating patients with classic AMN lesions and previously unreported underlying aetiologies.
  
  
  RESULTS
  Six patients were included (five women, one man, mean age 30±7 years). Mean distance best corrected visual acuity at initial presentation was 0.21±0.3 logMAR (mean Snellen acuity: 20/30, range 20/15-20/100) and at last follow-up visit 0.09±0.17 logMAR (Snellen acuity: 20/20, range 20/15-20/60). All cases but one had bilateral lesions and showed typical parafoveal hyporeflective lesions on infrared imaging, which corresponded to the hyper-reflectivity in the Henle's layer with attenuation of the external limiting membrane, the ellipsoid zone and interdigitation zone. Underlying diseases included thrombocytopenia and anaemia associated with dengue fever, acute lymphoblastic leukaemia, chronic kidney disease and ulcerative colitis, while Valsalva-like manoeuvre was found to be a potential trigger. Other novel associations included the use of lisdexamphetamine.
  
  
  CONCLUSIONS
  Classic AMN may be associated with leukaemia, dengue fever, ulcerative colitis and chronic kidney disease, probably as a result of chorioretinal hypoxia in the setting of thrombocytopenia and anaemia. Adrenergic agonists such as lisdexamphetamine may also contribute to the manifestation of AMN.
authors: Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA Department of Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland.
authors: Marion R
authors: MR
authors: Munk
authors: Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Lee M
authors: LM
authors: Jampol
authors: University of Sao Paulo, Sao Paulo, Brazil.
authors: Eduardo
authors: E
authors: Cunha Souza
authors: Retina Clinic, São Paulo, Brazil Department of Ophthalmology, Federal University of São Paulo-UNIFESP/EPM, São Paulo, Brazil.
authors: Gabriel Costa
authors: GC
authors: de Andrade
authors: Retina-Vitreous Associates Medical Group, Los Angeles, California, USA.
authors: Daniel D
authors: DD
authors: Esmaili
authors: Jules Stein Eye Institute, UCLA Greater LA VA Healthcare Center, Los Angeles, California, USA.
authors: David
authors: D
authors: Sarraf
authors: Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Amani A
authors: AA
authors: Fawzi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000740:Anemia / Q000150:complications; D003093:Colitis, Ulcerative / Q000150:complications; D003715:Dengue / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology*; D055351:Retinal Neurons / Q000473:pathology*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000150:complications; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D055815:Young Adult
keywords: Imaging; Macula; Retina