Authors: Wang Zhili, Chen Xiao, Liu Hui, Li Xiang
To analyze the clinical features of paracentral acute middle maculopathy(PAMM).
A retrospective series case observation was carried out.Clinical data of 11 eyes from 11patients with PAMM were included in this study from January 2016 to December 2017 in Henan Eye Hospital.All of the patients received general information inquiry, regular ophthalmic examination, color fundus photography, fundus infrared imaging(IR), spectral-domain optical coherence tomography (SD-OCT), OCT angiography(OCTA), fundus fluorescence angiography(FFA), visual field examination and multifocal electroretinography.
The ages of the patients ranged from 50 to 71 years old, with the average age of 60 years old.There were 9 males and 2 females, including hypertension in 3 patients, hypertension carotid atherosclerotic plaque in 1 patientd, diabetes with carotid stenosis in 2 patients, hypertension with diabetes in 2 patients, only carotid atherosclerotic plaque in 2 patients and chest trauma in 1 patient.The symptoms of PAMM were central or paracentral scotoma within 1 week.The best corrected visual acuity(BCVA) of the patients ranged from 0.6 to 1.0.All of the patients had central or paracentral scotoma or decrease of visual sensitivities.Mf-ERG showed that amplitude density of P1 waves was reduced in 8 eyes.With subtle-white lesion was seen in fundus of 8 eyes and no obvious symptom in 3 eyes.IR imaging demonstrated hypo-reflection in paracentral macula area in all eyes, and their FFA imaging seemed normal.SD-OCT scanning across lesion area revealed hyper-reflection in inner nuclear layer(INL). OCTA demonstrated perfusion deficit in deep capillary plexuses(DCP). After treatment, there was no improvement in BCVA for all the eyes but scotomas were lessened.
PAMM easily occurs in older males with systemic diseases.PAMM lesson is a occult paramacular middle layer of retinopathy.The combination examination of morphological and functional methods is avaiable for diagnosis.