Título

ACUTE PARACENTRAL MIDDLE MACULOPATHY (PAMM) IN POSTOPERATIVE BARIATRIC SURGERY: A CASE REPORT

Objetivo

Describe a case of PAMM in a patient with a diagnosis of non-ischemic central retinal vein occlusion. We emphasize the presence of this retinal vascular event arising in a postoperative context of a bariatric surgery.

Métodos

Case report

Resultados

60-year-old woman was referred to ophthalmological evaluation reporting sudden and painless visual loss in the right eye for 48 hours. Previous medical history remarkable included bariatric surgery 10 months prior with no other diseases.
Previous vision was 20/20 bilaterally. On current examination BCVA was 20/200 in right eye (OD) and 20/20 in left eye (OS), with no noteworthy biomicroscopy findings. Fundus evaluation of OD revealed tortuosity and dilatation of the retinal veins, irregular areas of deep retinal clearing centered around the macula throughout venous tributaries, as well as a small superficial intraretinal hemorrhage and a normal OS. Fluorescein angiography revealed non-ischemic central retinal vein occlusion (CRVO) without macular edema in the OD, optical coherence tomography (OCT) revealed a hyperreflexivity band in the inner nuclear layer, with no quantitative change in relation to macular thickness.
Two weeks after, OD BCVA remained 20/200 with dark spots in the visual field reported by the patient. Novel fundus examination revealed anatomical resolution of the OVCR. Follow-up with serial OCT evidenced retinal thinning at the expense of the inner layers of the retina.

Discussão e Conclusões

PAMM is seen as a more superficial variant of acute middle neuroretinopathy, describing changes in the intermediate layers of the retina.
Bariatric surgery has several postoperative complications stated, may including ischemic consequences in microvasculature due to inflammatory process and the whole pos-operative context. However its association with retinal vascular phenomena has not yet been described. Its pathogenesis may include vasogenic mechanism, which should be involved in the genesis of deep capillary plexus ischemia and development of such disease.

Palavras Chave

PARACENTRAL MIDDLE MACULOPATHY, BARIATRIC, SURGERY

Área

Clínica