Paracentral acute middle maculopathy as preamble of retinal vascular occlussion. The importance of an accurate follow-up.

Author: Lucia Santana-Garcia (Spain)

Co-authors: Zaida Miguelez Llamera, Ana Maria Pereira Delgado, Eduardo Manuel Pastenes Zhilin, Neyla Carolina Esaa Caride, Pablo Soler Bartrina, Marina Rodriguez Andres

Purpose

To analyse Paracentral Acute Middle Maculopathy (PAMM) focussing on its spectral-domain optical coherence tomographic (SD-OCT) findings and highlighting its relationship with vascular occlusions of the retina.

Setting/Venue

PAMM has recently been associated with numerous retinal vascular diseases including retinal vein or artery occlusion and hypoperfusion of the cilioretinal artery. To date, near-infrared reflectance, fundus autofluorescence and SD-OCT imaging remain the most sensitive modalities. En-face OCT and OCT-angiography have emerged as promising tools in the management too.

Methods

We report a case of a unilateral central acute onset negative scotoma in a 68-year-old patient with no other visual symptoms. Funduscopic examination did reveal no significant abnormalities; one subtle whitish parafoveal lesion deeper within the retina and a narrowing of the vessel close to it were perceptible. The OCT-scan showed a hyperreflective band-like at the inner nuclear layer with near-infrared reflectance imaging.

Results

A complete work-up was performed to diagnose and prevent other cardiovascular systemic damage. As a result of an accurate follow-up, 6 months later, a branch retinal artery embolus was diagnosed.

Conlusions

As the clinical appearance can be quite subtle by funduscopic examination, reliance on supplemental diagnostic imaging techniques is critical. A complete study of cardiovascular risk factors should be performed. A rigorous follow-up of the patient is necessary since occlusion in retinal vessels may appear in the following months to the presentation of PAMM.

Financial Disclosure

None

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