Título

PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH ARTERIOLAR OCCLUSION.

Introdução / Purpose

Describe a young patient with Paracentral Acute Middle Maculopathy (PAMM). Angiography suggests arterial occlusion. PAMM is a type 1 variant of Acute Macular Neuroretinopathy characterized by focal or diffuse hyperreflective band-like lesions, at the level of internal nuclear layer in Optical Coherence Tomography (OCT), associated with ischemic retinal vascular changes.

Material e Método / Methods

Woman, 38 years old, obese, with sudden low visual acuity (VA) and peripheral visual field defect on right eye. Past medical history unremarkable. Denies viral prodrom and use of vasoconstrictor medications. VA of 20/60 and 20/20 right and left eye. Refraction of -2.00 (sph) in both eyes. Biomicroscopy of anterior segment without alterations, intraocular pressure of 11 mmHg in both eyes. Funduscopy of the right eye shows a discrete temporal pallor on the optic disc, reduction of the foveal reflex. Left eye presents no particularities.

Resultados / Results

OCT shows an area of hyperreflectivity of the inner layers. Angiography of the right eye presents atypical images suggesting retinal arterial branch occlusion and left eye discrete perfusion changes. Computerized Campimetry, 24-2 Thereshold Test, presents upper and lower temporal scotomas in both eyes. Systemic investigation and coagulability unremarkable.

Discussão e Conclusões / Discussion

This case demonstrates the importance to ophthalmologists in recognizing that PAMM is a clinical finding, which may be a complex feature of a retinal vasculopathy or underlying systemic disease and may even be the only sign of its presence. PAMM should be suspected in the face of nonspecific complaints or absence of signals.PAMM has recently been associated with numerous vascular diseases of the retina including diabetic, hypertensive, sickle cell, and purtscher retinopathy, central retinal vein occlusion and branch and central retinal arterial occlusion.

Palavras Chave

retinal , optical coherence tomography, diseases