The clinical and multimodal imaging characteristics of paracentral acute middle maculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Mengyang , Qian Tong , Li Xiaoxin , Sun Guosheng , Hu Jie , Wang Zongyi , Zhao Mingwei ,  Qu Jinfeng

Department of Ophthalmology, Peking University People’s Hospital Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid DiseasesCollege of Optometry, Peking University Health Science Center, Beijing 100044, China;

Corresponding author：

Qu Jinfeng, Email: drbari@163.com

Keywords：

Tomography, optical coherence; Regional blood flow; Paracentral acute middle maculopathy; Multimodal imaging characteristics

DOI：

10.3760/cma.j.issn.1005-1015.2019.04.002

Video：

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Objective To observe the clinical and multimodel imaging characteristics of paracentral acute middle maculopathy (PAMM).Methods Retrospective case series study. From January 2014 to August 2018, 12 eyes of 12 patients with PAMM diagnosed in Department of Ophthalmology, Peking University People’s Hospital, were included in this study. There were 9 males and 3 females, with the mean age of 57 years. All patients were referred for sudden impaired vision, with or without paracentral scotoma. The patients underwent BCVA, slit lamp examination, fundus photography, FFA and OCT. Simultaneously, OCT angiography (OCTA) was performed in 10 eyes, visual field was performed in 5 eyes, near infrared fundus photography was performed in 1 eye. Clinical and multimodal imaging findings were reviewed and analyzed.Results Among 12 eyes, there were 5 eyes with BCVA 0.05-≤0.1, 4 eyes with BCVA 0.3-0.5, 3 eyes with BCVA 0.6-1.0. There were 1 eye with central rentinal artery obstruction (CRAO), 7 eyes with branch retinal artery obstruction (BRAO). Among them, BRAO with central retinal vein occlusion (CRVO) in 1 eye, with non-arteritic anterior ischemic optic neuropathy in 1 eye, with diabetic retinopathy in 1 eye; old BRAO in 3 eyes; pure BRAO in 1 eye. There were 4 eyes with pure CRVO, including 3 eyes with ischemic CRVO. All eyes demonstrated hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT. En face OCT highlighted the areas with hyperreflectivity corresponding to these lesions. OCTA demonstrated significant deep capillary dropout, abnormal morphology and enlargement of foveal avascular zone.Conclusion Hyperreflective band-like lesions at the level of the inner nuclear layer on OCT and middle retinal perivascular hyperreflectivity on en face scan are characteristic in PAMM.

Citation： Li Mengyang, Qian Tong, Li Xiaoxin, Sun Guosheng, Hu Jie, Wang Zongyi, Zhao Mingwei, Qu Jinfeng. The clinical and multimodal imaging characteristics of paracentral acute middle maculopathy. Chinese Journal of Ocular Fundus Diseases, 2019, 35(4): 322-326. doi: 10.3760/cma.j.issn.1005-1015.2019.04.002 Copy

1.	Sarraf D, Rahimy E, Fawzi AA, et al. Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia[J]. JAMA Ophthalmol, 2013, 131(10): 1275-1287. DOI: 10.1001/jamaophthalmol.2013.4056.
2.	Rahimy E, Kuehlewein L, Sadda SR, et al. Paracentral acute middle maculopathy: what we knew then and what we know now[J]. Retina, 2015, 35(10): 1921-1930. DOI: 10.1097/IAE.0000000000000785.
3.	Nemiroff J, Kuehlewein L, Rahimy E, et al. Assessing deep retinal capillary ischemia in paracentral acute middle maculopathy by optical coherence tomography angiography[J]. Am J Ophthalmol, 2016, 162: 121-132. DOI: 10.1016/j.ajo.2015.10.026.
4.	Nemiroff J, Phasukkijwatana N, Sarraf D. Optical coherence tomography angiography of deep capillary ischemia[J]. Dev Ophthalmol, 2016, 56: 139-145. DOI: 10.1159/issn.0250-3751.
5.	李世迎, 赵晨, 张敏芳, 等. 急性黄斑旁中心中层视网膜病变二例[J]. 中华眼底病杂志, 2017, 33(6): 642-643. DOI: 10.3760/cma.j.issn.1005-1015.2017.06.023.Li SY, Zhao C, Zhang MF, et al. Acute paracentral acute middle maculopathy- two cases reports[J]. Chin J Ocul Fundus Dis, 2017, 33(6): 642-643. DOI: 10.3760/cma.j.issn.1005-1015.2017.06.023.
6.	周伟, 胡兴兴, 韩梅, 等. 高血压性视网膜病变合并继发性急性黄斑旁中心中层视网膜病变一例[J]. 中华眼底病杂志, 2019, 35(2): 192-193. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.016.Zhou W, Hu XX, Han M, et al. Hypertensive retinopathy with secondary paracentral acute middle maculopathy[J]. Chin J Ocul Fundus Dis, 2019, 35(2): 192-193. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.016.
7.	Rosenfeld PJ, Durbin MK, Roisman L, et al. Zeiss Angioplex^TM spectral domain optical coherence tomography angiography: technical aspects[J]. Dev Ophthalmol, 2016, 56: 18-29. DOI: 10.1159/000442773.
8.	Chen X, Rahimy E, Sergott RC, et al. Spectrum of retinal vascular diseases associated with paracentral acute middle maculopathy[J]. Am J Ophthalmol, 2015, 160(1): 26-34. DOI: 10.1016/j.ajo.2015.04.004.
9.	Creese K, Ong D, Sandhu SS, et al. Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery[J]. Clin Exp Ophthalmol, 2017, 45(6): 598-605. DOI: 10.1111/ceo.12945.
10.	Nakashima H, Iwama Y, Tanioka K, et al. Paracentral acute middle maculopathy following vitrectomy for proliferative diabetic retinopathy: incidence, risk factors, and clinical characteristics[J]. Ophthalmology, 2018, 125(12): 1929-1936. DOI: 10.1016/j.ophtha.2018.07.006.
11.	Garrity ST, Paques M, Gaudric A, et al. Considerations in the understanding of venous outflow in the retinal capillary plexus[J]. Retina, 2017, 37(10): 1809-1812. DOI: 10.1097/IAE.0000000000001784.
12.	Bakhoum MF, Freund KB, Dolz-Marco R, et al. Paracentral acute middle maculopathy and the ischemic cascade associated with retinal vascular occlusion[J]. Am J Ophthalmol, 2018, 195: 143-153. DOI: 10.1016/j.ajo.2018.07.031.
13.	Fawzi AA, Pappuru RR, Sarraf D, et al. Acute macular neuroretinopathy: long-term insights revealed by multimodal imaging[J]. Retina, 2012, 32(8): 1500-1513. DOI: 10.1097/IAE.0b013e318263d0c3.
14.	Chu S, Nesper PL, Soetikno BT, et al. Projection-resolved oct angiography of microvascular changes in paracentral acute middle maculopathy and acute macular neuroretinopathy[J]. Invest Ophthalmol Vis Sci, 2018, 59(7): 2913-2922. DOI: 10.1167/iovs.18-24112.
15.	Sridhar J, Shahlaee A, Rahimy E, et al. Optical coherence tomography angiography and en face optical coherence tomography features of paracentral acute middle maculopathy[J]. Am J Ophthalmol, 2015, 160(6): 1259-1268. DOI: 10.1016/j.ajo.2015.09.016.
16.	Spaide RF, Klancnik JM Jr, Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography[J]. JAMA Ophthalmol, 2015, 133(1): 45-50. DOI: 10.1001/jamaophthalmol.2014.3616.

1. Sarraf D, Rahimy E, Fawzi AA, et al. Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia[J]. JAMA Ophthalmol, 2013, 131(10): 1275-1287. DOI: 10.1001/jamaophthalmol.2013.4056.
2. Rahimy E, Kuehlewein L, Sadda SR, et al. Paracentral acute middle maculopathy: what we knew then and what we know now[J]. Retina, 2015, 35(10): 1921-1930. DOI: 10.1097/IAE.0000000000000785.
3. Nemiroff J, Kuehlewein L, Rahimy E, et al. Assessing deep retinal capillary ischemia in paracentral acute middle maculopathy by optical coherence tomography angiography[J]. Am J Ophthalmol, 2016, 162: 121-132. DOI: 10.1016/j.ajo.2015.10.026.
4. Nemiroff J, Phasukkijwatana N, Sarraf D. Optical coherence tomography angiography of deep capillary ischemia[J]. Dev Ophthalmol, 2016, 56: 139-145. DOI: 10.1159/issn.0250-3751.
5. 李世迎, 赵晨, 张敏芳, 等. 急性黄斑旁中心中层视网膜病变二例[J]. 中华眼底病杂志, 2017, 33(6): 642-643. DOI: 10.3760/cma.j.issn.1005-1015.2017.06.023.Li SY, Zhao C, Zhang MF, et al. Acute paracentral acute middle maculopathy- two cases reports[J]. Chin J Ocul Fundus Dis, 2017, 33(6): 642-643. DOI: 10.3760/cma.j.issn.1005-1015.2017.06.023.
6. 周伟, 胡兴兴, 韩梅, 等. 高血压性视网膜病变合并继发性急性黄斑旁中心中层视网膜病变一例[J]. 中华眼底病杂志, 2019, 35(2): 192-193. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.016.Zhou W, Hu XX, Han M, et al. Hypertensive retinopathy with secondary paracentral acute middle maculopathy[J]. Chin J Ocul Fundus Dis, 2019, 35(2): 192-193. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.016.
7. Rosenfeld PJ, Durbin MK, Roisman L, et al. Zeiss Angioplex^TM spectral domain optical coherence tomography angiography: technical aspects[J]. Dev Ophthalmol, 2016, 56: 18-29. DOI: 10.1159/000442773.
8. Chen X, Rahimy E, Sergott RC, et al. Spectrum of retinal vascular diseases associated with paracentral acute middle maculopathy[J]. Am J Ophthalmol, 2015, 160(1): 26-34. DOI: 10.1016/j.ajo.2015.04.004.
9. Creese K, Ong D, Sandhu SS, et al. Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery[J]. Clin Exp Ophthalmol, 2017, 45(6): 598-605. DOI: 10.1111/ceo.12945.
10. Nakashima H, Iwama Y, Tanioka K, et al. Paracentral acute middle maculopathy following vitrectomy for proliferative diabetic retinopathy: incidence, risk factors, and clinical characteristics[J]. Ophthalmology, 2018, 125(12): 1929-1936. DOI: 10.1016/j.ophtha.2018.07.006.
11. Garrity ST, Paques M, Gaudric A, et al. Considerations in the understanding of venous outflow in the retinal capillary plexus[J]. Retina, 2017, 37(10): 1809-1812. DOI: 10.1097/IAE.0000000000001784.
12. Bakhoum MF, Freund KB, Dolz-Marco R, et al. Paracentral acute middle maculopathy and the ischemic cascade associated with retinal vascular occlusion[J]. Am J Ophthalmol, 2018, 195: 143-153. DOI: 10.1016/j.ajo.2018.07.031.
13. Fawzi AA, Pappuru RR, Sarraf D, et al. Acute macular neuroretinopathy: long-term insights revealed by multimodal imaging[J]. Retina, 2012, 32(8): 1500-1513. DOI: 10.1097/IAE.0b013e318263d0c3.
14. Chu S, Nesper PL, Soetikno BT, et al. Projection-resolved oct angiography of microvascular changes in paracentral acute middle maculopathy and acute macular neuroretinopathy[J]. Invest Ophthalmol Vis Sci, 2018, 59(7): 2913-2922. DOI: 10.1167/iovs.18-24112.
15. Sridhar J, Shahlaee A, Rahimy E, et al. Optical coherence tomography angiography and en face optical coherence tomography features of paracentral acute middle maculopathy[J]. Am J Ophthalmol, 2015, 160(6): 1259-1268. DOI: 10.1016/j.ajo.2015.09.016.
16. Spaide RF, Klancnik JM Jr, Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography[J]. JAMA Ophthalmol, 2015, 133(1): 45-50. DOI: 10.1001/jamaophthalmol.2014.3616.

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