Paracentral Acute Middle Maculopathy in Giant Cell Arteritis

Abstract

Purpose: To report the occurrence of paracentral acute middle maculopathy (PAMM) in giant cell arteritis (GCA), describe its features and outcomes, and identify risk factors associated with PAMM in patients with GCA.Methods: Review of medical records of patients with GCA who were examined in the Rothschild Foundation Hospital. Patients were divided into three groups: GCA with PAMM (Group 1), GCA with ophthalmic involvement but without PAMM (Group 2), and GCA without ophthalmic involvement (Group 3). We analyzed the data for age, sex, medical history, laboratory testing, visual acuity, and posterior segment vascular involvement.Results: Among the 96 patients who met the inclusion criteria, 52 had ophthalmic involvement, and 16 patients were included in Group 1 (GCA with PAMM). In this subgroup, the mean age was 81.6 years and was found to be older than other groups. The visual prognosis was similar between Groups 1 and 2. Of the 20 eyes with PAMM, 35% were also associated with homolateral anterior ischemic optic neuropathy. No statistical difference was found in initial symptoms, signs, and laboratory testing.Conclusion: Paracentral acute middle maculopathy is frequently observed lesions in ocular GCA. Patients can present with isolated findings of PAMM as the only indication of GCA. Optical coherence tomography of the macula should be routinely performed in patients with suspected GCA, specifically if they complain of visual changes, to look for signs of ischemia in the middle layers of the retina. Isolated PAMM should raise suspicion for GCA in patients at risk.

Choroidal ischemia as one cardinal sign in giant cell arteritis

“…There was a subtle (4–6%) decrease of the choroidal vascularity index in eyes with A-AION vs. eyes with non-A-AION or vs. control eyes. The most recently characterized instance of vascular involvement is PAMM [ 33 ]. This hyperreflective parafoveal white band is located at the level of INL, is best seen on OCT-A, and develops into deeper layer atrophy as a result of selective obstruction of the deeper retinal vascular plexus [ 13 ].…”

Detection of paracentral acute middle maculopathy (PAMM) can prevent blindness and death

“…Of the ocular cases, PAMM on OCT was identified in 16 eyes (30.8%) and was the only ocular finding in 7 eyes (13.4%). As expected in GCA, the most frequent ophthalmologic finding was A-AION, but the second most frequent ocular feature was PAMM as detected by OCT. 25 Therefore, PAMM can be a critical finding leading to the diagnosis of GCA in a significant proportion of patients.…”

“…Recent reports suggest that PAMM may be the only ocular sign leading to the diagnosis of giant cell arteritis (GCA) or carotid occlusive disease and so detection of this OCT finding can be critical especially when isolated. [24][25][26] Paracentral Acute Middle Maculopathy as a Sign of Giant Cell Arteritis Serum erythrocyte sedimentation rate was urgently acquired and was elevated (63 mm/hour. Normal , 20 mm/hour).…”

“…Recent reports suggest that PAMM may be the only ocular sign leading to the diagnosis of giant cell arteritis (GCA) or carotid occlusive disease and so detection of this OCT finding can be critical especially when isolated. 24–26…”

“…In a retrospective study including 96 patients with GCA, Mairot et al 25 reported ocular involvement in 52 cases (54.2%). Of the ocular cases, PAMM on OCT was identified in 16 eyes (30.8%) and was the only ocular finding in 7 eyes (13.4%).…”