Título / Title

PARACENTRAL ACUTE MIDDLE MACULOPATHY FOLLOWING PHACOEMULSIFICATION CATARACT SURGERY - CASE REPORT

Introdução / Purpose

Paracentral acute middle maculopathy (PAMM) is an spectral-domain optical coherence tomography (SD-OCT) abnormality related to ischemia of the deep retinal circulation, not a distinct retinal disease
It appears most commonly in patients with risk factors for retinal ischemia, including diabetes mellitus, arterial hypertension, sickle cell disease, flu-like illness and orbital compression
Typically there is an irreversible visual loss, with paracentral scotoma and no significant findings at fundoscopy
Cataract surgery is the most commonly performed operation by ophthalmologists and generally has excellent outcomes. Recently, PAMM has been considered as an important differential diagnosis in cases of low visual acuity with scotoma

Material e Método / Methods

To report a case and review of the literature

Resultados / Results

Male, 80 years old, sought ophthalmologic care, with sudden visual loss and painless in the left eye (OS) associated with paracentral scotoma, one week after a facectomy in the left eye. He had a record of uncomplicated surgery and visual acuity (VA) of 20/20 postoperative
Pathological antecedents: arterial hypertension
Ophthalmologic exam: VA of 20/60 in OS, without further changes
OCT of macula: hyperreflective areas in the middle layers and hyporreflective in the outer layers
Fluorescein angiography: enlargement of the avascular zone of the fovea
Prednisolone acetate was prescribed, without significant improvement of visual acuity on follow up

Discussão e Conclusões / Conclusion

The described patient presents the typical PAMM SD-OCT, with hyper-reflective band-like lesions involving the middle layers of retina, allowing to close the diagnosis. There is no currently treatment, only the treatment of vasculopathic risk factors when present, according to irreversible visual loss in the case
PAMM may appear after a facectomy and should be considered as a differential diagnosis in cases of visual loss with paracentral scotomas

Palavras Chave

Paracentral acute middle maculopathy, spectral domain optical coherence tomography, cataract surgery