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About the Author Dr. Andrew Rouse is a graduate of SUNY College of Optometry Class of 2022. He completed a residency in ocular disease and is currently working at the Bascom Palmer Eye Institute in Miami, FL.
References and Acknowledgements Moura-Coelho N et al. Paracentral acute middle maculopathy – review of the literature. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2020; 258(10). Sarraf D et al. Paracentral Acute Middle Maculopathy: A New Variant of Acute Macular Neuroretinopathy Associated With Retinal Capillary Ischemia. JAMA Ophthalmol. 2013; 131(10): 1275-1287. Chu S, Nesper PL,
ConclusionsPAMM is a result of ischemia to middle retinal layers.Common in vascular disorders with reports in other atypical cases.No treatment, however, workup is indicated.
71-year-old female with history of iron deficiency anemia, type 2 diabetes and hypertension presented with acute vision loss Pinhole VA OS: CF at 3 feetFundus photo of the left eye showing diffuse intraretinal hemorrhages and scattered Roth Spot hemorrhages. The retinal veins are dilated and tortuous and there’s an area of retinal whitening in
41-year-old female with no pertinent medical history presented with acute vision loss Pinhole VA OS: 20/60Fundus photo of the left eye with retinal whitening sparing areas around retinal vasculatureOCT showing multiple, focal, middle retinal layer hyper-reflectivityAfter workup was performed, this patient was diagnosed with antiphospholipid syndrome
71-year-old male with history of hypertension presented with acute vision loss Pinhole VA OD: 20/200Fundus photo showing diffuse retinal whitening sparing the nasal macular zone due to cilioretinal perfusion and macular cherry red spot.OCT with diffuse middle retinal hyperreflectivity sparing the nasal macular zone.This patient was diagnosed with a central retinal artery occlusion with
Extra Cases Case 1 Case 3 Note: notice the cilio-retinal artery in Case 1 (left image) and Case 3 (right image).
Summary of the Case 67-year-old diabetic presenting with acute symptoms of a PVDIncidental finding of retinal ischemia characterized by PAMM lesions and CWS, otherwise asymptomatic.Few weeks later developed more classic appearance of CRAO with cherry red spotStroke workup unremarkable
OCT of the left eye showing a more diffuse hyper-reflectivity of the middle retinal layers and early inner retinal atrophy nasal to the macula.
Fundus photo of the left eye. Media opacity is impacting view in. PVD is now visualized. More distinct retinal whitening with cherry red spot
