This 63YO patient complained of a recent scotoma in the mid-periphery of her right eye. Vision was 20/20 OU. She gave a history of hypertension with a recent elevated BP of 200/110. She denied a history of diabetes.
Fundus photography shows a patch of deep retinal whitening in the temporal macula. There were a few scattered dot and blot retinal hemorrhages in the right eye, which may have been related to her recently elevated blood pressure.
OCT shows a well-demarcated hyperreflective region spanning the inner plexiform, inner nuclear, and outer plexiform layers. Wide-field en face OCT shows a placoid area of hyperreflectivity within this region. Wide-field OCT angiography of the deep capillary plexus shows a relative flow defect within this area.
Learning Points:
Paracentral acute middle maculopathy (PAMM) is a recently-described phenotype. It consists of acute mid-retinal ischemia found as an idiopathic entity or in other ocular disorders, including Purtscher’s, diabetic retinopathy, retinal artery and retinal vein occlusions, and acute macular neuroretinopathy.
For a great recent review, see Scharf et al, Progress in Retinal and Eye Research 2021;81;100884.
