• Yong Guo, Chenjun Guo, Yan Li, Yongkang Zhang, Xiaozhan Liu, and Houcheng Liang.
• Xi'an BRIGHT Eye Hospital Group Co Ltd. Xi'an, Shaanxi, China.
• Medicine (Baltimore). 2025 Jan 17; 104 (3): e41076e41076.

RationaleMacular damage is a rare yet significant ocular complication of coronavirus disease 2019 (COVID-19) infection. This report highlights the clinical features, diagnosis, treatment, and outcomes in 2 cases of COVID-19-associated macular damage, contributing to the understanding of its pathophysiology and management.Patient ConcernsBoth patients presented with a sudden onset of visual impairment and black shadows in their central visual fields shortly after contracting COVID-19.DiagnosesThe first patient, a 15-year-old male, was diagnosed with acute macular neuroretinopathy, evidenced by optical coherence tomography (OCT) imaging showing high-density shadows in the macular area. The second patient, a 28-year-old female, presented with more extensive macular lesions, confirmed via fundus photography and OCT imaging.InterventionsBoth patients received systemic corticosteroid therapy (oral prednisone acetate, 30 mg daily). The male patient was treated for 5 days, while the female patient underwent a 3-day treatment course.OutcomesThe male patient showed significant improvement in visual acuity, with OCT imaging revealing the resolution of high-density shadows but persistent disruption of the ellipsoid zone. The female patient demonstrated partial improvement in visual symptoms, though residual macular abnormalities remained evident on imaging.LessonsCOVID-19-associated macular damage appears to involve inflammatory and vascular mechanisms. Early systemic corticosteroid therapy may offer symptomatic relief and partially restore visual function. However, long-term monitoring is essential to address potential residual or progressive retinal damage.Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.

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