Title

CENTRAL RETINAL VEIN OCCLUSION AND PARACENTRAL ACUTE MIDDLE MACULOPATHY: A CASE REPORT

Introduction

Paracentral Acute Middle Maculopathy (PAMM) is characterized by hyperreflective bands and focal or diffuse lesions at the level of inner nuclear layers (INL). With a probable vascular etiology, risk factors include arterial hypertension, diabetes mellitus, sickle cell disease and retinal vascular occlusions.

Methods

To report a case of PAMM secondary to Central Retinal Vein Occlusion.

Results

A 70-year-old female presented with sudden vision loss in the right eye. She had hypertension and diabetes mellitus and was under treatment for Primary Open Angle Glaucoma. Best corrected visual acuity was 20/70 in the right eye and 20/30 in the left eye. Fundoscopic examination of the right eye revealed scattered intraretinal haemorrhages in four quadrants and dilated and tortuous retinal veins. Examination of the left eye was unremarkable. Anterior segment and intraocular pressure were normal bilaterally. The patient referred previous allergic reaction to contrast, reason why fluorescein angiography could not be performed. OCT of the right eye revealed absence of edema, hyperreflective band-like in the inner nuclear layer suggestive of Paracentral Acute Middle Maculopathy. OCT angiography vascular flow void in the deep capillary plexus (DCP) of the right eye. The patient was referrred to anti-VEFG treatment.

Discussion

In 2014, Rahimi et al. described a group of patients with nonischemic CRVO associated with PAMM . The pathogenesis is until now not quite understood, but it is believed that a transient hypoperfusion of the DCP is associated with PAMM manifestations. In the setting of CRVO, oxygen saturation of blood diminishes, affecting the most susceptible tissues. In summary, CRVO can cause significant vision loss due several mechanism, as macular edema, macular ischemic changes, or as a sequela of complication related to retinal neovascularization. In the absence of these findings, it is important to exclude features suggestive of PAMM, as it can be a cause of vision loss.

Keywords

Paracentral Acute Middle Maculopathy, Central Retinal Vein Occlusion.

Area

CLINICAL CASE

Authors

João Jorge Nassaralla Neto, Delma Regina Gomes Huarachi, Matheus Schwengber Gasparini, Arthur Pinheiro Favarato, Erick Carneiro Holanda, Vicente Hidalgo Rodrigues Fernandes, Iuri Cardoso Silva, Maurício Abujamra Nascimento