Paracentral acute middle maculopathy (PAMM) is a recently described manifestation presenting with hyperreflective bands within mid retina on spectral domain optical coherence tomography (SD OCT). The current view is that these findings are markers of ischaemia of deep retinal circulation. They have been reported to be either idiopathic, occurring in healthy subjects or in systemic conditions and retinal vascular disorders such as central retinal vein occlusion (CRVO). Flourescein angiography (FA), the current gold standard to visualise retinal ischaemia, shows the superficial capillary plexus in detail; however, the intermediate and deep capillary plexus (DCP) are not seen. The authors retrospectively report the clinical course and the OCT angiographic (OCTA) findings of a case series of patients presenting with PAMM and CRVO. Clinical records and multimodal imaging findings of patients presenting with PAMM and CRVO were reviewed. Three eyes (right: left 2:1) of three patients (two males; one female, mean age: 66 years) were included in the study. Mean follow-up was nine months and images using OCTA (AngioVue OCT angiography system, Optovue, Inc., Fremont, CA, USA) were available at the last follow-up visit. In case 1, the best corrected visual acuity (BCVA) was unchanged at 85 ETDRS letters and OCTA revealed a mild attenuation of the perifoveal DCP. In case 2, BCVA changed from 83 to 77 ETDRS letters and OCTA revealed patchy areas of attenuation and pruning of the DCP. In case 3, BCVA decreased from 26 to eight ETDRS letters and OCTA revealed extensive areas of DCP dropout. The natural course of visual acuity in patients with PAMM secondary to CRVO may vary. In these patients, the extent of DCP dropout on OCTA may reflect the extent of visual acuity impairment.

Optical coherence tomography angiography in paracentral acute middle maculopathy secondary to central retinal vein occlusion.
Casalino G, Williams M, McAvoy C, et al.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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