Título / Title

PARACENTRAL ACUTE MIDDLE MACULOPATHY AND BRANCH RETINAL ARTERY OCCLUSION AFTER RETINAL LASER SESSION IN A PATIENT WITH SICKLE CELL RETINOPATHY: A CASE REPORT

Introdução / Purpose

To report a case of paracentral acute middle maculopathy (PAMM) in the right eye (OD) and branch retinal artery occlusion (BRAO) in the left eye (OS) after retinal laser session in a patient with sickle cell retinopathy

Material e Método / Methods

Review of the patient's medical record

Resultados / Results

A 18-year-old man, previously diagnosed with sickle cell retinopathy in both eyes (OU), underwent retinal photocoagulation treatment for peripheral retinal nonperfusion with a panfundoscopic contact lens. The patient returned two days after the procedure complaining of paracentral scotomas and worsening of visual acuity (VA) in the OS. No triggering factor for sickle cell crisis, such as dehydration or infection, was noted. On physical examination, VA decreased from 20/20 to 20/25 in OD and from 20/20 to 20/60 in OS. Fundoscopy showed cotton wool spot in the OD and retinal whitening along the temporal inferior arteriole in the OS. OCT performed on the same day showed thinning of retinal layers probably related to sickle cell retinopathy in the OD and retinal whitening and edema along the temporal inferior arteriole in the OS. Patient was diagnosed with BRAO in the OS and was opted for expectant management. After 4 days, the VA was 20/20 in the OD and 20/100 in the OS. At new OCT, a hyperreflective image was noted at the level of the ganglion cell layer and inner nuclear layer temporal to the fovea in the OD, suggestive of PAMM. OCT-angiography demonstrated areas of hypoperfusion in the deep capillary plexuses in the OD, at the same area of b-scan alterations, corroborating the hypothesis of PAMM. Without interventions, patient evolved with improvement in VA. After 6 months, he presented VA 20/20 in OU and regression of lesions. OCT showed thinning of the inner retinal layers as a sequel of recurrent local ischemic damage in OU.

Discussão e Conclusões / Conclusion

Pressure applied to the eyeball during retinal photocoagulation may cause transient occlusion or reduction of flow in retinal arterioles and favor vascular occlusions in predisposed patients

Palavras Chave

sickle cell retinopathy; PAMM; vascular occlusion; laser; photocoagulation, retina

Area

CLINICAL RETINA