Título

OCT ANGIOGRAPHY FINDINGS IN A CASE OF PARACENTRAL ACUTE MIDDLE MACULOPATHY

Introdução / Purpose

To present a case of paracentral acute middle maculopathy (PAMM) and highlight the diagnostic feature of the disease on OCT and discuss their OCT-A findings.

Material e Método / Methods

This is a case report of a 73 year-old male with systemic arterial hypertension and type 2 diabetes. He was referred because of acute blurred vision in the left eye observed two weeks earlier. Best-corrected visual acuity was 20/25 in the right eye and count fingers in the left eye. Ophthalmoscopy showed large optic disc, with optic disc cup ratio of 0.8 and arteriolar narrowing in both eyes. Intraocular pressure was 10 mmHg in both eyes. Fluorescein angiography was unremarkable. Spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) were then performed.

Resultados / Results

Spectral-domain optical coherence tomography (SD-OCT) showed a hyper-reflective band-like lesion involving the middle layers of the retina at the level of the inner nuclear layer (INL). OCT angiography (OCTA) revealed a mild attenuation of the superficial capillary plexus and a more extensive perfusion defect in the deep capillary plexus.

Discussão e Conclusões / Discussion

PAMM refers to a characteristic hyper-reflective, band-like SD-OCT lesion involving the middle layers of the retina at the level of the INL. PAMM lesions reside histologically at the level of the intermediate and deep capillary plexus, indicating that ischemia of these plexi may be the cause.
PAMM may also be a complicating feature of an underlying retinal vasculopathy, such as diabetic retinopathy or retinal vascular occlusion. Our case is probably secondary to arterial vascular occlusion. PAMM may be difficult to detect clinically or with fluorescein angiography. OCTA quantifies time-related differences in erythrocyte reflectivity to render flow maps of the retinal circulation with segmentation capabilities not afforded by dye-based angiography. Our case imaged PAMM with OCTA demonstrating areas of attenuation particularly at the level of the deep capillary plexus.

Palavras Chave

paracentral acute middle maculopathy; optical coherence tomography