Abstract:  Objective To observe the characteristic multimodal imaging features of acute macular neuroretinopathy (AMN) after COVID-19 infection. Design Retrospective case series. Participants Eleven patients (22 eyes) diagnosed with AMN following COVID-19 infection at Handan Eye Hospital between December 2022 and February 2024, who completed one-year follow-up. All patients presented with visual decline within 1~5 days. The cohort included 2 males and 9 females, all with bilateral involvement, aged 16~44 years (mean 29.9±9.1 years). Methods All patients underwent multimodal imaging including color fundus photography (CFP), infrared (IR) imaging, autofluorescence (AF) imaging, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA). Imaging characteristics were documented. Follow-up examinations were conducted within 1 week and at 1, 3, 6 months, and 1 year after onset.  Main Outcome Measures Imaging features on CFP, IR, AF, OCT, FFA, and ICGA. Results In the acute phase: all eyes exhibited radial, patchy, or wedge-shaped grayish-white and orange-red lesions in the macular area on CFP, and irregular patchy hyporeflective lesions were observed on IR. AF showed speckled hyperfluorescence in 7 eyes. Late-phase ICGA displayed patchy hypofluorescence in 7 eyes. OCT demonstrated patchy hyperreflective signals primarily involving the outer plexiform layer (OPL) and outer nuclear layer (ONL) in all eyes. Visual field testing revealed central or paracentral scotomas in 19 eyes. At 1-year follow-up, CFP showed no abnormalities in all eyes. Late-phase ICGA showed slight reduction of patchy hypofluorescence. OCT indicated thinning of the OPL in 12 eyes, among which 7 eyes showed focal ellipsoid zone (EZ) disruption. Visual field abnormalities(central or paracentral scotomas) persisted in 14 eyes. Conclusions AMN in the acute phase exhibits distinct characteristic findings on CFP and OCT. At 1-year follow-up, some patients still present with central or paracentral scotomas. 

Key words: COVID-19, Acute macular neuroretinopathy, Color fundus photography, Infrared imaging, Auto fluorescence imaging, Optical coherence tomography, Fundus angiography