Ultra-high-resolution imaging of acute macular neuroretinopathy: a case report

We report the case of a 38-year-old woman presenting with acute bilateral paracentral scotomas in the context of a COVID-19 infection. Multimodal imaging confirmed the diagnosis of acute macular neuroretinopathy (AMN). Flood-illumination adaptive optics (FlAO) imaging was used to monitor photoreceptor structural anatomy over an 11-month period, providing high-resolution longitudinal data. FIAO analysis revealed a marked reduction in cone reflectivity in the affected areas at baseline, followed by partial restoration of the cone mosaic at follow-up, likely reflecting outer segment recovery. To date, only few reports have described the use of adaptive optics in AMN with extended follow-up. This case highlights the utility of advanced imaging techniques in characterizing the evolution of pathologies such as AMN and monitoring their progression over time. • FIAO imaging revealed reduced cone reflectivity with partial mosaic recovery at 11 months. • FIAO findings spatially corresponded to EZ and ONL damage on SD-OCT. • Cone density increased by 28%, consistent with outer segment recovery. • FIAO enables in vivo photoreceptor-level monitoring beyond conventional imaging.