Paracentral Acute Middle Maculopathy Associated With Anterior Ischemic Optic Neuropathy and Cilioretinal Artery Occlusion in Giant Cell Arteritis

Abstract

:Paracentral acute middle maculopathy (PAMM) is a relatively new optical coherence tomography finding, defined by hyperreflectivity in the inner nuclear layer. In this article, we present a case of a 73-year-old woman who presented with transient vision loss followed by the sudden onset of complete vision loss to counting fingers at 1 foot for one day in the left eye. Dilated examination showed a right cotton wool spot, left pallid optic disc edema, and retinal edema in the distribution of the cilioretinal artery. OCT demonstrated hyperreflective band at the level of the inner nuclear layer, compatible with PAMM. Clinical and laboratory findings were consistent with GCA, for which she was prescribed high-dose oral prednisone, with confirmation of GCA on a subsequent temporal artery biopsy. PAMM may be seen in the context of GCA, and OCT of the macula serves as an important adjunct to define the retinal manifestations of this condition.

Paracentral Acute Middle Maculopathy (Pamm) in Giant Cell Arteritis

“…The SCP represents 60% of the fluorescence during FFA, and the relative contribution of ischemia in the ICP or DCP can easily be missed. 9 Nevertheless, in case of PAMM, FFA can provide information regarding the etiology of the PAMM lesion (cilioretinal obstruction versus central retinal artery occlusion versus CRVO) and may also show evidence of choroidal ischemia in the setting of GCA. Fundus autofluorescence (FAF) in PAMM can show an hypoautofluorescent lesion from the affected inner retina, which blocks normal outer retina autofluorescence signal.…”

“…OCT was consistent with a diagnosis of PAMM because of GCA. Kasimov and coworkers 9 recently described a case of a 73-year-old woman who presented with transient vision loss followed by the sudden onset of complete vision loss to counting fingers at 1 foot for 1 day OS. Dilated examination showed a CWS OD, pallid optic disk edema OS, and retinal edema in the distribution of the cilioretinal artery.…”