This 68YO male presented on 12/11/23 with a several-day history of a paracentral scotoma in his right eye. Vision was 20/30 OD and 20/25 in his normal OS.
Triton color imaging shows an area of retinal opacification in the superior macula. This area is hyperreflective on swept-source OCT. The lesion gradually resolved over several months. When last examined on 5/20/24, the funduscopic appearance normalized. The area of prior mid-retinal hyperreflectivity was replaced by retinal thinning, with the inner plexiform/inner nuclear/outer plexiform layers compressed into a single hyperreflective line.
Learning Points:
Paracentral acute middle 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 (Bousquet et al, Retina 2023;43:1827-1832).
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. Our patient’s medical evaluation was fortunately negative.
