OCT angiography features of paracentral acute middle maculopathy

Abstract

Paracentral acute middle maculopathy (PAMM) refers to retinal lesions with changes in the inner nuclear layer on spectral domain optical coherence tomography (OCT). PAMM is associated with retinal vascular pathology involving the deep capillary plexus. We report two cases of PAMM in Indian subjects using multimodal imaging highlighting the OCT angiography (OCTA) findings. The first case is of a middle-aged female with a paracentral scotoma with SS-OCT (swept-source optical coherence tomography) and OCTA findings suggestive of “chronic” PAMM. The second case presented with sudden decreased vision, and multiple creamy white lesions suggestive of “acute” PAMM, imaging features depicting a possible venular obstruction. These cases demonstrate the importance of considering PAMM as a differential diagnosis in patient presenting with nonspecific visual complains and apparently normal ophthalmic examination. The recognition of PAMM should prompt an appropriate evaluation and investigation.

Late PAMM-Like Lesions in a Patient with HIV Retinopathy

“…In our patient, along with the classical manifestations of HIV microangiopathy, we detected areas of focal INL atrophy, fulfilling the morphologic and VF characteristics of late-stage PAMM [8‒10]. The early stage of these lesions was not detected, possibly because the patient failed to pay attention and timely report ocular manifestations due to other severe and life-threatening symptoms.…”

Paracentral Acute Middle Maculopathy As the Presenting Sign of Ischemic Cardiomyopathy

“…The OCT is invaluable in confirming the diagnosis of PAMM as band-like multiple or isolated hyperreflectivity in the OPL-INL whereas AMN displays hyperreflectivity of the OPL and outer nuclear layer (ONL) and may be associated with disruption of the ellipsoid zone (EZ) [ 1 ]. The OCT angiography (OCTA) shows reduced flow in the intermediate retinal capillary plexus (ICP) and deep capillary plexus (DCP) in PAMM, whereas AMN is associated with reduced flow in the DCP only [ 7 , 8 ]. Three distinct patterns of these lesions were observed in en-face OCT: arteriolar, globular, and perivenular fern-like [ 1 , 9 , 10 ].…”

Paracentral Acute Middle Maculopathy as the Initial Presentation of Giant Cell Arteritis

“…Spectral-domain optical coherence tomography (SD-OCT) shows hyper-reflective band-like lesions limited to the level of the inner nuclear layer. Recent studies of OCT angiography (OCT-A) suggest that PAMM is associated with vascular ischemia involving the deep capillary plexus (2,3). En face OCT shows placoid or globular hyper-reflective bands at the level of the deep vascular complex.…”

“…Although PAMM can occur as an isolated phenomenon, it is often the result of retinal vascular pathology. Thus, PAMM lesions can occur secondary to local retinal ischemic injury, such as retinal vascular occlusion, or as a manifestation of a systemic disease with vascular risk factors such as diabetic retinopathy (3).…”