Spectral-domain optical coherence tomography in paracentral acute middle maculopathy associated with vasopressor exposure

Abstract

Visual field deficits are a common presentation in optometric practice. Patients often report a unilateral or bilateral scotoma and decreased visual acuity. These symptoms are frequently accompanied by fundoscopic changes usually indicating an underlying macular pathology or optic nerve disorders. However, some patients present with a sudden onset of paracentral scotomas that affect one or both eyes. Paracentral scotomas are typically the only symptoms experienced by patients, as visual acuity is unaffected and fundus examination shows no abnormalities. Such a subtle presentation can indicate a diagnosis of paracentral acute middle maculopathy (PAMM) among other maculopathies, but the key to the diagnosis are retinal changes visible on spectral-domain optical coherence tomography images (SD-OCT). On SD-OCT scans, PAMM lesions present as a hyperreflective parafoveal band at the level of the inner nuclear layer and outer plexiform layer, which evolve into permanent inner nuclear layer thinning. Paracentral acute middle maculopathy is believed to be a manifestation of focal ischaemia of the deep retinal circulation. The underlying conditions associated with PAMM lesions vary widely and include various retinal, vascular, or systemic diseases including diabetic retinopathy, hypertensive retinopathy, sickle cell retinopathy, Purtscher retinopathy, central retinal vein occlusion, or retinal artery occlusion, as well as environmental risk factors such as vasopressor exposure (e.g. caffeine intake), dehydration, or oral contraceptive. In this report, we describe the clinical course and imaging findings of a single case of paracentral acute middle maculopathy secondary to hypertensive retinopathy, migraine, and vasopressor exposure.