title: Acute Macular Neuroretinopathy Following Non-Ocular Trauma: A Hypothesis Regarding Pathophysiologic Mechanism.
abstract: OBJECTIVE
  To describe the imaging characteristics and clinical course of acute macular neuroretinopathy (AMN) following non-ocular trauma, and to hypothesize a pathophysiologic mechanism for this syndrome.
  
  
  METHODS
  The records of five patients who developed symptoms and findings suggestive of AMN following trauma to the face or chest were retrospectively reviewed. Optical coherence tomography (OCT), infrared reflectance, fundus autofluorescence, fluorescein and indocyanine green angiography, and multifocal electroretinography were evaluated.
  
  
  RESULTS
  Visual symptoms started immediately or very soon after non-ocular trauma, and scotomas persisted at last follow-up (2 weeks to 10 years after trauma). OCT imaging performed within days of the trauma demonstrated focal areas of hyper-reflectivity in the outer plexiform and outer nuclear layers with eventual thinning of the outer nuclear layer, as well as variable loss of the ellipsoid and interdigitation zones.
  
  
  CONCLUSIONS
  Acute ischemic injury caused by trauma-induced hypotension and/or catecholamine release and involving the deep retinal capillary plexus is the pathogenic mechanism that most plausibly explains trauma-associated AMN.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Chinskey
authors.forename: Ehsan
authors.initials: E
authors.lastname: Rahimy
authors.forename: Mark W
authors.initials: MW
authors.lastname: Johnson
mesh_terms: D000063:Accidents, Traffic; D000208:Acute Disease; D002395:Catecholamines / Q000378:metabolism; D004396:Coloring Agents / Q000008:administration & dosage; D004596:Electroretinography; D005131:Eye Injuries / Q000503:physiopathology*; D005151:Facial Injuries / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D008266:Macula Lutea / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015814:Ocular Hypotension / Q000209:etiology; D012164:Retinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D055351:Retinal Neurons / Q000502:physiology*; D012189:Retrospective Studies; D012607:Scotoma / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D013898:Thoracic Injuries / Q000209:etiology; D041623:Tomography, Optical Coherence; D014949:Wounds, Nonpenetrating / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D002395:Catecholamines; D004396:Coloring Agents; D007208:Indocyanine Green