Paracentral Acute Middle Maculopathy After Endovascular Coil Embolization

Abstract

Purpose: To describe two cases of paracentral acute middle maculopathy (PAMM) that occurred unilaterally after endovascular coil embolization.Methods: Medical records including ophthalmic examinations of two PAMM cases were retrospectively reviewed.Results: The first case was a 64-year-old woman with hyperlipidemia and chronic sinusitis. The second case was a 49-year-old man with hypertension, hyperlipidemia, tension headache, and vertigo. Both cases exhibited paracentral scotomas just after endovascular coil embolization. Ophthalmoscopy showed multiple faint white-yellow lesions in each affected eye. Optical coherence tomography showed hyper-reflective bands that were mainly observed in the inner nuclear layer and corresponded to the PAMM lesions. Optical coherence tomography angiography revealed variable degrees of abnormal vasculature from slight dilation, decreased visualization, to nonvisualization in the superficial capillary plexuses and similar capillary changes in deep capillary plexuses. Conclusion:We described two cases with PAMM that occurred after endovascular coil embolization, which was a new precursor cause of PAMM. Our results demonstrate that optical coherence tomography angiography is especially useful for not only diagnosis, but also for follow-up evaluations in patients with PAMM.

Paracentral acute middle maculopathy following internal carotid artery stenting

“…PAMM has been reported after endovascular coil embolization 10 and after cardiac catheterization. 11 , 12 In their case report of PAMM following cardiac catheterization, Schmitt and colleagues proposed that the ischemia may have occurred secondary to an embolism induced by intra-aortic vascular trauma.…”

Paracentral acute middle maculopathy after diagnostic cerebral angiography in a patient with a contralateral carotid-cavernous fistula

“…In asymptomatic patients, such as our case, OCT may be an essential diagnostic procedure that allows an early detection. Currently, there is no treatment for PAMM, although its management should be targeted toward the identification and treatment of related vascular risk factors, when present, in order to avoid visual and neurological sequelae [3,[5][6][7][8] . The cavernous sinus is a complex venous structure that is anastomosed anteriorly and posteriorly between the right and left sides.…”

“…This association is rare, but medical comorbidities of our patient (arterial hypertension, type 2 diabetes, and history of a vertebrobasilar stroke), could produce a previous retinal vascular alteration, favoring the ischemia of the intermediate and deep capillary plexus. Furthermore, PAMM has been reported in association with endovascular procedures, but otherwise has not been described after a diagnostic cerebral angiography [3,[7][8] . In these cases, iatrogenic rupture of atheromatous plaques and endothelial injury during microcatheter insertion might be the origin of PAMM [7][8] .…”

“…Furthermore, PAMM has been reported in association with endovascular procedures, but otherwise has not been described after a diagnostic cerebral angiography [3,[7][8] . In these cases, iatrogenic rupture of atheromatous plaques and endothelial injury during microcatheter insertion might be the origin of PAMM [7][8] . Diagnostic cerebral angiography is an invasive procedure that involves carotid and vertebral artery catheterisation.…”

Difficulty in articulation following left progressive blurred vision

“…In a few published reports, some cases were idiopathic, but diabetes mellitus, hypertension, hypotension, hyperlipidemia, sickle cell disease, hemophilia, viral illness, human immunodeficiency virus infection, migraine, prolonged hypoxia, hypothyroidism, glaucoma, pregnancy, factor V Leiden deficiency, post-cardiac catheterization, transient orbital compression, and intraocular surgeries could be possible risk factors for PAMM. 4–7 In this report, we share a unique case simultaneously diagnosed with PAMM and lacunar infarction because of severe internal carotid artery (ICA) stenosis. To date, no case report has presented the correlation between PAMM and ICA stenosis.…”