Paracentral Acute Middle Maculopathy Associated With Retinal Artery Occlusion After Cosmetic Filler Injection

Sridhar, Jayanth; Shahlaee, Abtin; Shieh, Wen-Shi; Rahimy, Ehsan

doi:10.1097/icb.0000000000000466

Cited by 16 publications

(9 citation statements)

References 11 publications

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“…Many studies reveal a wide spectrum of systemic and ocular conditions related to PAMM, primarily among patients with cardiovascular pathology. PAMM has been shown in patients with hypertension, sickle-cell disease, 13 after mitral valve implantation, 14 Purtscher's retinopathy, 15 after filler injections, 16 in occlusive retinal vasculitis, and other conditions which compromise the blood clotting system, including antiphospholipid syndrome, 17 in giant cell arteritis, 18 and COVID-19. 19 On the other hand, several cases describe PAMM lesions in individuals with an unremarkable medical history.…”

Section: Discussionmentioning

confidence: 99%

Choriocapillaris alteration in patients with paracentral acute middle maculopathy

Maltsev

Kulikov

Burnasheva

2022

European Journal of Ophthalmology

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Purpose To evaluate with optical coherence tomography angiography the status of the choriocapillaris in the eyes of patients with resolved paracentral acute middle maculopathy (PAMM). Methods Nine patients with unilateral resolved PAMM, 14 age-matched healthy individuals, and 16 age-matched patients with unilateral retinal vein occlusion (RVO) were included. The choriocapillaris flow area, and the number of choriocapillaris flow voids was compared between the eyes of healthy individuals, both eyes of the PAMM patients, and the fellow eyes of unilateral RVO patients. Results The number of choriocapillaris flow voids in the unaffected eyes of PAMM patients was statistically significantly higher than in the eyes of healthy individuals (p < 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.022). The choriocapillaris flow area in the unaffected eyes of PAMM patients was statistically significantly lower than in the eyes of healthy individuals (p < 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.019). There was no difference in the status of the choriocapillaris between two eyes of PAMM patients. Conclusion Eyes of patients with resolved PAMM have a substantial decrease of choriocapillaris perfusion.

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Section: Discussionmentioning

confidence: 99%

Choriocapillaris alteration in patients with paracentral acute middle maculopathy

Maltsev

Kulikov

Burnasheva

2022

European Journal of Ophthalmology

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“…PAMM has been associated with reduced blood flow of the SCP and DCP, 2 MCP alone, 7 or MCP and DCP. 1 , 5 , 9 – 11 Similarly, AMN has been associated with occlusion of the DCP 4 , 12 or choriocapillaris. 13 , 14 The two major confounding factors in all these studies are projection artifacts cast from superficial blood vessels onto the deeper layers, and artifactual OCT signal attenuation underneath INL/ONL hyperreflective lesions.…”

mentioning

confidence: 99%

“… 7 The underlying and precipitating pathologies associated with these lesions vary widely, but they generally share a vascular origin. 5 , 8 – 10 …”

mentioning

confidence: 99%

Projection-Resolved OCT Angiography of Microvascular Changes in Paracentral Acute Middle Maculopathy and Acute Macular Neuroretinopathy

Chu

Nesper

Soetikno

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PurposeTo identify the microvascular changes associated with paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) and to improve our understanding of the relevant involvement of the three retinal capillary plexuses using projection-resolved optical coherence tomography angiography (PR-OCTA).MethodsThis was a retrospective study of 18 eyes with AMN or PAMM imaged with OCTA. We used cross-sectional PR-OCTA to localize reduced flow signal to the superficial (SCP), middle (MCP), or deep capillary plexus (DCP) or choriocapillaris that corresponded to inner retinal PAMM or outer retinal AMN lesions on OCT.ResultsFive eyes with AMN showed outer retinal disruption on OCT associated with reduced DCP flow signal. All three eyes with AMN and follow-up had recovery of DCP flow. Thirteen eyes with PAMM showed middle retinal disruption on OCT associated with reduced flow signal in both the MCP and DCP. Of these, five also had reduced flow signal in the SCP. All 10 eyes with PAMM and follow-up showed variable recovery of flow signal in one or more plexuses. PAMM reperfusion was primarily arterial in nature. Three eyes with PAMM and no evidence of MCP reperfusion experienced severe thinning of the inner nuclear layer (INL), while seven eyes with robust MCP flow signal recovery showed relative preservation of INL thickness.ConclusionsUsing PR-OCTA, we found that AMN was associated with reduced DCP flow signal, while PAMM was associated with reduced MCP and DCP flow signal and occasionally the SCP. The MCP appears to be important in sustaining INL thickness in these eyes.

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“…There have been multiple reports of PAMM identi ed in the setting of incomplete CRAO. 7,8 Our case is unique in that none of the clinical ndings of retinal artery occlusion -retinal whitening, arterial attenuation or delayed lling on angiography -were present on the initial exam. The PAMM lesion described here likely resulted from a separate thromboembolic event which spontaneously resolved so that the area of retinal infarction was limited to that most susceptible to watershed ischemia.…”

Section: Discussionmentioning

confidence: 79%

Paracentral Acute Middle Maculopathy Presenting as a Sign of Impending Central Retinal Artery Occlusion: A Case Report

Louie

Tang

King

2023

Preprint

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Background: To report a case of paracentral acute middle maculopathy (PAMM) that progressed to central retinal artery occlusion (CRAO) on spectral domain-optical coherence tomography (SD-OCT). Case Presentation: A 63-year-old male presented with a paracentral scotoma that began several days ago. His past medical history consisted of third degree atrioventricular heart block requiring a pacemaker. Giant cell arteritis was ruled out after erythrocyte sedimentation rate and c-reactive protein levels were normal. SD-OCT revealed a characteristic hyperreflective band in the inner nuclear layer consistent with PAMM in his left eye. Fluorescein angiography was obtained and demonstrated an area of non-perfusion in the parafoveal region. Five days later, the patient developed no light perception in the left eye. SD-OCT showed a diffuse inner retinal hyperreflectivity consistent with CRAO. Conclusion: PAMM can be a harbinger event for complete CRAO. Complete stroke evaluation should be performed to prevent a cerebrovascular event or progression to complete blindness in the involved eye.

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Paracentral Acute Middle Maculopathy Associated With Retinal Artery Occlusion After Cosmetic Filler Injection

Abstract: Emboli from cosmetic facial filler injections may rarely result in ipsilateral arterial occlusions and now have a novel association with paracentral acute middle maculopathy likely due to deep capillary plexus feeder vessel occlusion.

Cited by 16 publications

References 11 publications

Choriocapillaris alteration in patients with paracentral acute middle maculopathy

Choriocapillaris alteration in patients with paracentral acute middle maculopathy

Projection-Resolved OCT Angiography of Microvascular Changes in Paracentral Acute Middle Maculopathy and Acute Macular Neuroretinopathy

Paracentral Acute Middle Maculopathy Presenting as a Sign of Impending Central Retinal Artery Occlusion: A Case Report

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