Paracentral Acute Middle Maculopathy Treated with Acupuncture: A Case Report

Abstract

Case Report A 25-year old male patient visited the Department of Ophthalmology in Xiyuan Hosipital of China Academy of Chinese Medical Sciences on July 11, 2017, with a 4-day history of blocked vision of the left eye without obvious diminution of vision. Physical examination revealed that he had a headache, with a dusky red tongue, thin coating, wiry pulse, and elevated blood pressure (170/100 mm Hg). Clinical history revealed that he had marked myopia of both eyes for more than 10 years. On ocular examination, his vision was –9.50 DS in the right eye and –10.0 DS in the left, best corrected vision acuity of both eyes was 1.0. Intraocular pressure was 18 mm Hg in the right eye and 19 mm Hg in the left. The patient exhibited clear corneas and no keratic precipitate or conjunctiva congestion, mild depth of anterior chamber, no Tyndall phenomenon, no drifting opacities, and clear iris textures. Pupils were equal in size (diameter 3 mm), with binocular reflection of light, transparent lens, and slight opacity of the corpus vitreum. Fundas examination revealed tessellated retina in both eyes, red optic discs with clear border, slightly retinal vascular tortuosity, and a cuneiform white lesion with unclear border on the nasal side of macula lutea in the left eye (arrow in Figure 1A-a). On visual fi led examination, a dark zone was observed on the periphery of nasal side of the left eye, the 300 vision fi eld suggests a local vision defect (Figure 1A-b). Optical coherence tomography (OCT) revealed that high reflectance zones were scattered between the outer plexiform layer (OPL) and the inner plexiform layer (IPL) on paracentral region of nasal side of fovea in the left eye (arrow in Figure 1A-c). Fundus fl uorescein angiography (FFA) showed that the fi lling times of the artery and central vein of the left eye were approximately normal (16 and 25 s, respectively, Figure 2). Laboratory examination revealed no obvious abnormality in routine blood test, biochemistry, blood clotting tetrachoric, anti-nuclear antibodies, or erythrocyte sedimentation rate. Clinical diagnosis was PAMM, with CM syndrome of qi stagnation and blood stasis.