Título / Title

PARACENTRAL ACUTE MIDDLE MACULOPATHY: CASE REPORT

Introdução / Purpose

Paracentral acute middle maculopathy (PAMM) refers to a recently described class of characteristic SD-OCT lesions involving the middle layers of the retina at the level of the inner nuclear layer (INL) correlating with a paracentral area of deep retinal whitening on biomicroscopy. Symptoms includes sudden onset scotoma, visual decline, floaters, metamorphopsia and photopsia. Prognosis usually is good with improvement of visual acuity.

Material e Método / Methods

Medical records and literature review about PAMM.

Resultados / Results

Male, 55 year old, no comorbidities, complaining from acute lower vision on left eye (OS) for about 48h in Suel Abujamra Institute. Pacient denied previous trauma or ophthalmologic issues. He referred also a "blue blur" on left eye.
At this moment, BCVA was OR: 20/25 and OS: 20/30. Biomicroscopy was unremarkable. IOP 14/16mmHg;
Indirect ophthalmoscopy showed hypertensive retinopathy stage 2 in both eyes and a concentric ring-shaped perifoveal pallor and reddish foveola aspect on OS.
SD-OCT (OR): unremarkable; (OS) Hyperreflectivity bands at the INL-OPL juction.
Angiofluoresceinography: unremarkable in both eyes.
Visual field (OR):unremarkable; (OS): presence of central and paracentral scotomas in the upper quadrant.
Laboratorial exams and cardiology evaluation were request to exclude other pathologies, finding only poor blood pressure control.

Discussão e Conclusões / Conclusion

PAMM was initially described as a novel variant of AMN, but after further studies, this two abnormalities were found as different entities involving different retinal layers. Characteristically PAMM appear on OCT as placoid, hyperreflective bands at the level of the INL, sparing the outer retina, conversely, the hyperreflective band-like AMN lesions develop slightly lower at the junction of the OPL and ONL and may be associated disruption of the ellipsoid zone. Extrinsic factors can be associated with PAMM as vasopressor medication, migraines, hypovolemia and others.

Palavras Chave

PAMM, AMN, retina,