Paracentral Acute Middle Maculopathy in Pregnancy

Chen, Xuejing; Desai, Shilpa J.; Baumal, Caroline R.

doi:10.1097/icb.0000000000000679

Cited by 15 publications

(15 citation statements)

References 10 publications

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“…Conventional OCT scanning using larger interscan separation may miss small lesions, potentially leading to an unnecessary neurologic work-up of the patient. Previous reports have shown PAMM lesions that were not large, [4][5][6] although they were larger than the lesion in the present report, and they were visible by ophthalmoscopy. A high index of suspicion is required to diagnose the full spectrum of PAMM lesions and the scan density of OCT angiographic examinations, or a comparable scan density with conventional OCT devices, would be required to image the associated pathologic changes in smaller lesions with a high degree of certainty.…”

Section: Discussioncontrasting

confidence: 71%

Diminutive Paracentral Acute Middle Maculopathy Lesion

Spaide

2021

RETINAL Cases &Amp; Brief Reports

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Purpose: To describe a transient positive scotoma and corresponding optical coherence tomography (OCT) structural and angiographic findings.Methods: The patient was evaluated with a comprehensive ophthalmic examination to include OCT structural and angiographic imaging with two different instruments, the Zeiss Plex Elite and the Optovue RTVue XR Avanti.Results: A 45-year-old man had a sudden onset of a positive scotoma in the visual field of the left eye. No abnormalities were noted by ophthalmoscopy or fundus photography. Optical coherence tomography angiography was performed to evaluate the macular perfusion status. With each instrument, a small hyperreflective area, 175 mm in diameter, was imaged in the inner nuclear layer. The OCT angiographic images suggested a small area of decreased perfusion in the deep capillary plexus. Except for the diminutive size, the lesion had an appearance suggestive of paracentral acute middle maculopathy. The symptoms lessened rapidly, and when examined 4 days later, the lesion was less hyperreflective. Two weeks after presentation, the positive scotoma was not present and there was no longer any hyperreflectivity in the inner nuclear layer.Conclusion: Detection of the lesion was aided by using OCT angiographic scans, which have a much higher scan density than conventional OCT evaluations. The diminutive abnormality was consistent with a paracentral acute middle maculopathy lesion, although smaller than those previously reported. Micro-paracentral acute middle maculopathy lesions should be considered in the differential diagnosis of positive scotomas.

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Section: Discussioncontrasting

confidence: 71%

Diminutive Paracentral Acute Middle Maculopathy Lesion

Spaide

2021

RETINAL Cases &Amp; Brief Reports

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“…Reperfusion occurred following a transient hypoperfusion results in increased production of reactive oxygen species, nitric oxide neurotoxicity, inflammation, and extravascular leakage. Reperfusion injury is associated with chronic changes of PAMM [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Paracentral Acute Middle Maculopathy and Central Retinal Venous Occlusion following Electrical Injury

Khazaei

Shariati

Shoeibi

et al. 2022

Case Reports in Ophthalmological Medicine

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Purpose. To report a case of central retinal vein occlusion (CRVO) and paracentral acute middle maculopathy (PAMM) following electric shock injury. Case Description. A 45-year-old male presented with a significant painless decreased vision in the right eye following an electrical injury of the right hand in his workplace. The best-corrected visual acuity (BCVA) of the right eye was 20/40. Funduscopic examination of the right eye revealed diffuse superficial and deep intraretinal hemorrhages, mild venous tortuosity, and an area of the pale retina. Optical coherence tomography (OCT) demonstrated hyperreflective band-like lesions in the middle retinal layers. Patchy areas of vascular flow void in deep capillary plexus seen in OCT angiography of the right eye were compatible with PAMM. Fluorescein angiography of the right eye was indicative of delayed venous filling suggestive of CRVO. The left eye was completely normal on exam and imaging. Conclusion. This report illustrates the occurrence of CRVO associated with PAMM following electric shock injury. Electrical injury leads to a wide range of retinal manifestations. Clinicians need to pay attention to any hyperreflectivity and thinning of middle retinal layers in OCT in cases with the presentation of sudden visual loss following electrical injuries.

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“… 5 , 6 The etiology of PAMM remains unknown. Although it is most often described in the context of primary retinal vascular disorders, 6 other systemic conditions are associated which include diabetes mellitus, blood dycrasias, hypercoaguable states (i.e, pregnancy), 7 , 8 and medication side effects (i.e phosphodiesterase-5 inhibitors). 9 PAMM is also reported following ocular surgery and trauma.…”

Section: Discussionmentioning

confidence: 99%

Transient vision loss associated with paracentral acute middle maculopathy detected on multi-modal imaging

Sengillo

Zhang

Sridhar

et al. 2021

American Journal of Ophthalmology Case Reports

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Purpose To report two patients with transient decreased vision and associated paracentral acute middle maculopathy (PAMM) lesions identified with multi-modal imaging, including what we believe to be the first documented patient of PAMM associated with iron deficiency anemia. Observations Case 1 is a 56-year-old man who experienced transient blurred vision one week following cardiac ablation for atrial fibrillation. Symptoms resolved by the time of presentation and visual acuity was 20/20 in each eye. Ocular examination was unremarkable aside from subtle discoloration within the papillomacular bundle in the right eye. Spectral domain optical coherence tomography (SD-OCT) revealed thickening of the middle retinal layers with a corresponding area of hyporeflectivity on the en face infrared image. This area of hyporeflectivity was confirmed on “structural” SD-OCT angiography, although no flow voids were identified. Fluorescein angiography was normal. Case 2 is a 25-year-old man with no past medical history who noted decreased central vision in his right eye upon awakening. Visual acuity was light perception in the right eye and 20/20 in the left eye. Posterior segment examination in the right eye showed tortuous retinal vessels and subtle pallor involving the superior part of the macula. SD-OCT showed thickening of the middle retinal layers of the superior macula with a corresponding area of hyporeflectivity on the en face infrared image. Systemic work-up was completed and identified severe iron deficiency anemia as the most likely inciting factor. In both cases, visual acuity was 20/20 in each eye at follow-up. Conclusions Small arterial occlusions of the retina remain difficult to diagnose and may represent a sequela of systemic disease. Multi-modal imaging is helpful in equivocal cases with subtle clinical findings. Importance The present case report illustrates the utility of multi-modal imaging in diagnosing transient ischemic events of the retina, and reports what we believe to be the first association of PAMM with iron deficiency anemia.

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Paracentral Acute Middle Maculopathy in Pregnancy

Abstract: Paracentral acute middle maculopathy lesions have been described in eyes with retinal vascular disease and in people with systemic vascular diseases or events. This is the first described case of a PAMM lesion in the absence of associated factors other than an uncomplicated pregnancy.

Cited by 15 publications

References 10 publications

Diminutive Paracentral Acute Middle Maculopathy Lesion

Diminutive Paracentral Acute Middle Maculopathy Lesion

Paracentral Acute Middle Maculopathy and Central Retinal Venous Occlusion following Electrical Injury

Transient vision loss associated with paracentral acute middle maculopathy detected on multi-modal imaging

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