Title
OCT DIAGNOSIS OF PAMM WITH CONTRAINDICATION TO ANTI-VEGF TREATMENT AND PANFOTOCOAGULATION PROPOSED AFTER ANGIOFLUORESCEINOGRAPHY - CASE REPORT
Introduction
Acute Paracentral Middle Maculopathy-PAMM is a clinical finding, designating the presence of an inner nuclear layer hyperreflective band in optical coherence tomography-OCT. Characterized by segmental retinal ischemia, selectively affecting the inner and outer plexiform nuclear layers due to ischemia of the intermediate and deep retinal capillary plexuses. Although AF-angiofluoresceinography is the gold standard method for the evaluation of retinal circulation, PAMM affected plexuses are not visualized with AF, which is useful for the study of ischemic diseases associated with the finding.
Methods
Retrospective case study, Imaging exams.
Results
PAN, female, 32 years old, complaining of sudden low visual acuity (VA) in left eye-EL, 2 days ago, referred to the retina sector to evaluate urgent treatment with anti-VEGF and panphotocoagulation, diagnosed with vein occlusion retinal artery in EL. During evaluation: Denies comorbidities and regular use of medication. On examination, she presented AV with the best correction of 20/20 in the ER and 20/200 in the EL. In retinal mapping, the ER presented normal retina to the periphery, in EL presented physiological optic disc, increased diffuse vascular tortuosity and presence of dot and blot hemorrhage in the four quadrants. In PA normal examination in ER and EL areas of hypofluorescence in the four quadrants. In OCT in non-altered ER, in OE presence of hyperreflective band lesion in inner nuclear layer in macular region. Diagnosis of PAMM, request for laboratory tests, referral to the hematology service and expectant management were made. After 1 week return with negative laboratory tests and opinion of inconclusive diagnostic hematology. Angiographic and VA improvement observed for 20/30 within 90 days.
Discussion
PAMM is a tomographic finding. Although FA is the gold standard for evaluation of retinal circulation, PAMM affected plexuses are not visualized with FA, which is useful in the study of ischemic diseases associated with the finding.
Keywords
PAMM, OCT, Angiography
Area
CLINICAL CASE
Authors
JARBAS DIAS FURTADO JR, RODRIGO SCHWARTZ PEGADO, LEONARDO ELOY SOUSA, JOSÉ DE MELO COSTA NETO, LUIZ GUSTAVO TONELLI REGIS, RENATA MARIA CEZARINO VALDETARO