This 81YO female presented with 1 week of a temporal paracentral scotoma in her left eye. Vision was 20/50 OS.
Color imaging shows an area of inner retinal opacification in the nasal macula. This area is hyperreflective on swept-source OCT. En face imaging shows another perspective for this lesion.
Two months later, the retinal opacification was smaller with a small area of secondary inner retinal thinning.
Due to our patient’s age and somewhat atypical appearance of the PAMM lesion, which involved both the inner and middle retinal layers, she was immediately referred to the nearest stroke center.
This revealed a critical ipsilateral internal carotid artery stenosis, which was successfully repaired with emergent surgery.
Learning Points:
Paracentral acute macular maculopathy (PAMM) is a phenotype caused by acute mid-retinal ischemia due to obstruction of the deep and intermediate capillary plexi. PAMM is associated with an increasing constellation of conditions, including retinal vein and artery occlusions. It is unclear if patients with a pure PAMM phenotype require an immediate stroke protocol referral.
In our practice, we have seen several elderly patients who developed a complete CRAO within days of presenting with PAMM, so we do send these patients for emergent evaluation. We do not believe that typical PAMM in younger patients or found as a secondary finding in other ocular conditions requires a stroke workup.
