Paracentral acute middle maculopathy: from diagnosis toward clinical perspectives

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

In this review of literature, we reviewed the current state of knowledge on paracentral acute middle maculopathy (PAMM). The diversity of clinical manifestations, a variety of related cardiovascular and ocular conditions, as well as reported idiopathic cases, allow considering PAMM as a distinct clinical phenomenon or a syndrome. Taking into account already described and potential associations with systemic and ocular morbidity, PAMM may apply for a place of an important clinical biomarker not only for ocular but for systemic disorders in a broad cohort of patients. However, the understanding of the pathophysiology of PAMM and of its actual clinical significance is far from complete, and further studies are warranted.

About the authors

Maria A. Burnasheva

S.M. Kirov Military Medical Academy

Email: maria.andreevna1@gmail.com

MD, ophthalmologist of the ophthalmology department. S.M. Kirov Military Medical Academy

Russian Federation, St. Petersburg

Alexei N. Kulikov

S.M. Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru
ORCID iD: 0000-0002-5274-6993

MD, PhD, Dr. Sci. (Med.), assistant professor, head of the ophthalmology department. S.M. Kirov Military Medical Academy

St. Petersburg

Dmitrii S. Maltsev

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: glaz.med@yandex.ru
ORCID iD: 0000-0001-6598-3982

MD, PhD, Cand. Sci. (Med.), Head of medical retina division of ophthalmology department S.M. Kirov Military Medical Academy

Russian Federation, St. Petersburg

References

  1. Bos PJ, Deutman AF. Acute macular neuroretinopathy. Am J Ophthalmol. 1975;80:573-84. https://doi.org/10.1016/0002-9394(75)90387-6
  2. Sieving PA, Fishman GA, Salzano T, Rabb MF. Acute macular neuroretinopathy: early receptor potential change suggests photoreceptor pathology. Br J Ophthalmol. 1984;68(4):229-234. https://doi.org/10.1136/bjo.68.4.229
  3. O’Brien DM, Farmer SG, Kalina RE, Leon JA. Acute macular neuroretinopathy following intravenous sympathomimetics. Retina. 1989;9(4): 281-286. https://doi.org/10.1097/00006982-198909040-00008
  4. Leys M, Van Slycken S, Koller J, Van de Sompel W. Acute macular neuroretinopathy after shock. Bull Soc Belge Ophtalmol. 1991;241:95-104
  5. Rait JL, O’Day J. Acute macular neuroretinopathy. Aust N Z J Ophthalmol. 1987;15(4):337-340. https://doi.org/10.1111/j.1442-9071. 1987.tb00093.x
  6. Gass JD, Hamed LM. Acute macular neuroretinopathy and multiple evanescent white dot syndrome occurring in the same patients. Arch Ophthalmol. 1989;107(2):189-193. https://doi.org/ 10.1001/archopht.1989.01070010195021
  7. Sieving PA, Fishman GA, Salzano T, Rabb MF. Acute macular neuroretinopathy: early receptor potential change suggests photoreceptor pathology. Br J Ophthalmol. 1984;68(4):229-234. https://doi.org/ 10.1136/bjo.68.4.229
  8. Feigl B, Haas A. Optical coherence tomography (OCT) in acute macular neuroretinopathy. Acta Ophthalmol Scand. 2000;78(6): 714-716. https://doi.org/10.1034/j.1600-0420.2000.078006714.x
  9. Watzke RC, Shults WT. Annular macular neuroretinopathy and multifocal electroretinographic and optical coherence tomographic findings. Retina. 2004;24(5):772-775. https://doi.org/10.1097/00006982-200410000-00014
  10. Monson BK, Greenberg PB, Greenberg E, et al. High-speed, ultra-high-resolution optical coherence tomography of acute macular neuroretinopathy. Br J Ophthalmol. 2007;91(1):119-120. https://doi.org/10.1136/bjo.2006.098871
  11. Hughes EH, Siow YC, Hunyor AP. Acute macular neuroretinopathy: anatomic localisation of the lesion with high-resolution OCT. Eye (Lond). 2009;23(11):2132-2134. https://doi.org/10.1038/eye.2008.430.
  12. Casalino G, Arrigo A, Romano F, et al. Acute macular neuroretinopathy: pathogenetic insights from optical coherence tomography angiography. Br J Ophthalmol. 2019;103(3):410-414. https://doi.org/10.1136/bjophthalmol-2018-312197
  13. Sarraf D, Rahimy E, Fawzi AA, et al. Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA Ophthalmol. 2013;131(10): 1275-1287. https://doi.org/10.1001/jamaophthalmol.2013.4056
  14. Michaelson IC, Campbell AC. The anatomy of the finer retinal vessels. Trans Ophthal Soc UK. 1940;60:71-111.
  15. Shah D, Saurabh K, Roy R. Multimodal imaging in paracentral acute middle maculopathy. Ind J Ophthalmol. 2018;66(8): 1186-1188. https://doi.org/10.4103/ijo.IJO_173_18
  16. Nakamura M, Katagiri S, Hayashi T, et al. Longitudinal follow-up of two patients with isolated paracentral acute middle maculopathy. Int Med Case Rep J. 2019;12:143-149. Published 2019 May 6. https://doi.org/10.2147/IMCRJ.S196047
  17. Dansingani KK, Freund KB. Paracentral Acute Middle Maculopathy and Acute Macular Neuroretinopathy: Related and Distinct Entities. Am J Ophthalmol. 2015;160(1):1-3.e2. https://doi.org/10.1016/j.ajo.2015.05.001
  18. Rahimy E, Sarraf D, Dollin ML, et al. Paracentral acute middle maculopathy in nonischemic central retinal vein occlusion. Am J Ophthalmol. 2014;158(2):372-380.e1. https://doi.org/10.1016/j.ajo.2014.04.024
  19. Browning DJ. Patchy ischemic retinal whitening in acute central retinal vein occlusion. Ophthalmology. 2002;109(11):2154-2159. https://doi.org/10.1016/s0161-6420(02)01217-4
  20. Rahimy E, Sarraf D. Paracentral acute middle maculopathy spectral-domain optical coherence tomography feature of deep capillary ischemia. Curr Opin Ophthalmol. 2014;25(3):207-212. https://doi.org/10.1097/ICU.0000000000000045
  21. Ramtohul P, Freund KB. Central Acute Middle Maculopathy: A Novel Variant of Paracentral Acute Middle Maculopathy in Foveal Hypoplasia. Ophthalmol Retina. 2020;4(3):344-347. https://doi.org/10.1016/j.oret.2019.10.003
  22. Yu S, Pang CE, Gong Y, et al. The spectrum of superficial and deep capillary ischemia in retinal artery occlusion. Am J Ophthalmol. 2015;159(1):53-63.e2. https://doi.org/10.1016/j.ajo.2014.09.027
  23. Pichi F, Fragiotta S, Freund KB, et al. Cilioretinal artery hypoperfusion and its association with paracentral acute middle maculopathy. Br J Ophthalmol. 2019;103(8):1137-1145. https://doi.org/10.1136/bjophthalmol-2018-312774
  24. da Fonseca MLG, Souza A, Pereira MB, et al. Paracentral acute middle maculopathy associated with hypoperfusion of the cilioretinal artery and impending central retinal vein occlusion. Eur J Ophthalmol. 2019;1120672119885787. https://doi.org/10.1177/1120672119885787
  25. McLeod D. En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein Occlusion. Am J Ophthalmol. 2017;182:203-204. https://doi.org/10.1016/j.ajo.2017.06.037
  26. Chen X, Rahimy E, Sergott RC, et al. Spectrum of Retinal Vascular Diseases Associated With Paracentral Acute Middle Maculopathy. Am J Ophthalmol. 2015;160(1):26-34.e1. https://doi.org/10.1016/j.ajo.2015.04.004
  27. Rahimy E, Kuehlewein L, Sadda SR, Sarraf D. Paracentral Acute Middle Maculopathy: What We Knew Then and What We Know. Now. Retina. 2015;35(10):1921-1930. https://doi.org/10.1097/IAE.0000000000000785
  28. Tokimitsu M, Murata M, Toriyama Y, et al. Delineation of capillary dropout in the deep retinal capillary plexus using optical coherence tomography angiography in a patient with Purtscher’s retinopathy exhibiting normal fluorescein angiography findings: a case report. BMC Ophthalmol. 2016;16:113. https://doi.org/10.1186/s12886-016-0298-x
  29. Sridhar J, Shahlaee A, Shieh WS, Rahimy E. Paracentral acute middle maculopathy associated with retinal artery occlusion after cosmetic filler injection. Retin Cases Brief Rep. 2017;11 Suppl 1: S216-S218. https://doi.org/10.1097/ICB.0000000000000466
  30. Khatibi A. Brazilian booty retinopathy: purtscher-like retinopathy with paracentral acute middle maculopathy associated with pmma injection into buttocks. Retin Cases Brief Rep. 2018;12(1):17-20. https://doi.org/10.1097/ICB.0000000000000380
  31. Shah D, Saurabh K, Roy R. Multimodal imaging in paracentral acute middle maculopathy. Ind J Ophthalmol. 2018;66(8): 1186-1188. https://doi.org/10.4103/ijo.IJO_173_18
  32. Baciu P, Nofar CM, Spaulding J, Gao H. Branch retinal artery occlusion associated with paracentral acute middle maculopathy in a patient with livedo reticularis. Retin Cases Brief Rep. 2017;11(4): 356-360. https://doi.org/10.1097/ICB.0000000000000370
  33. Trese MG, Thanos A, Yonekawa Y, Randhawa S. Optical Coherence Tomography Angiography of Paracentral Acute Middle Maculopathy Associated with Primary Antiphospholipid Syndrome. Ophthalmic Surg Lasers Imaging Retina. 2017;48(2):175-178. https://doi.org/10.3928/23258160-20170130-13
  34. Kido A, Uji A, Morooka S, et al. Outer Plexiform Layer Elevations as a Marker for Prior Ocular Attacks in Patients with Behcet’s Disease. Invest Ophthalmol Vis Sci. 2018;59(7):2828-2832. https://doi.org/10.1167/iovs.18-24348
  35. Carey A, Cohen S. Paracentral acute middle maculopathy in birdshot chorioretinopathy: a novel association. Retin Cases Brief Rep. 2016;10(2):151-153. https://doi.org/10.1097/ICB.0000000000000212.
  36. Hussnain SA, Coady PA, Stoessel KM. Paracentral acute middle maculopathy: precursor to macular thinning in sickle cell retinopathy. BMJ Case Rep. 2017;2017. https://doi.org/10.1136/bcr-2016-216124
  37. Ilginis T, Keane PA, Tufail A. Paracentral acute middle maculopathy in sickle cell disease. JAMA Ophthalmol. 2015;133(5):614-616. https://doi.org/10.1001/jamaophthalmol.2014.6098
  38. Cohen MN, Dang S, Liang MC. Paracentral Acute Middle Maculopathy After Cardiac Arrest. Ophthalmology. 2017;124(4):511. https://doi.org/10.1016/j.ophtha.2016.10.007
  39. Shahlaee A, Sridhar J, Rahimy E, Shieh WS, Ho AC. Paracentral acute middle maculopathy associated with postviral purtscher-like retinopathy. Retin Cases Brief Rep. 2019;13(1):50-53. https://doi.org/10.1097/ICB.0000000000000529
  40. Mine I, Taguchi M, Sakurai Y, Takeuchi M. Bilateral idiopathic retinal vasculitis following coxsackievirus A4 infection: a case report. BMC Ophthalmol. 2017;17(1):128. https://doi.org/10.1186/s12886-017-0523-2
  41. Haskes C, Santapaola S, Zinn J. An Atypical Case of Paracentral Acute Middle Maculopathy. Optom Vis Sci. 2017;94(8):845-850. https://doi.org/10.1097/OPX.0000000000001087
  42. Chen Y, Hu Y. The optical imaging of idiopathic paracentral acute middle maculopathy in a Chinese young man and review of the literature. Photodiagnosis Photodyn Ther. 2017;19:383-387. https://doi.org/10.1016/j.pdpdt.2017.07.004
  43. 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. Clin Exp Ophthalmol. 2017;45(6):598-605. https://doi.org/10.1111/ceo.12945
  44. Nakashima H, Iwama Y, Tanioka K, Emi K. Paracentral Acute Middle Maculopathy following Vitrectomy for Proliferative Diabetic Retinopathy: Incidence, Risk Factors, and Clinical Characteristics. Ophthalmology. 2018;125(12):1929-1936. https://doi.org/10.1016/j.ophtha.2018.07.006
  45. Ang MJ, Chen JJ, McDonald HR. Paracentral acute middle maculopathy after epiretinal membrane removal. Retin Cases Brief Rep. 2019. https://doi.org/10.1097/ICB.0000000000000883
  46. Gascon P, Briantais A, Bertrand E, et al. Covid-19-Associated Retinopathy: A Case Report. Ocul Immunol Inflamm. 2020;28(8): 1293-1297. https://doi.org/10.1080/09273948.2020.1825751
  47. Virgo J, Mohamed M. Paracentral acute middle maculopathy and acute macular neuroretinopathy following SARS-CoV-2 infection. Eye. 2020;34(12):2352-2353. https://doi.org/10.1038/s41433-020-1069-8
  48. Sridhar J, Shahlaee A, Rahimy E, et al. Optical Coherence Tomography Angiography and En Face Optical Coherence Tomography Features of Paracentral Acute Middle Maculopathy. Am J Ophthalmol. 2015;160(6):1259-1268.e2. https://doi.org/10.1016/j.ajo.2015.09.016
  49. Ghasemi Falavarjani K, Phasukkijwatana N, Freund KB, et al. En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein Occlusion. Am J Ophthalmol. 2017;177:131-138. https://doi.org/10.1016/j.ajo.2017.02.015
  50. Garrity ST, Tseng VL, Sarraf D. Paracentral acute middle maculopathy in a perivenular fern-like distribution with en face optical coherence tomography. Retin Cases Brief Rep. 2018;12 Suppl 1: S25-S28. https://doi.org/10.1097/ICB.0000000000000657
  51. Zhioua Braham I, Kaouel H, Boukari M, et al. OCT-angiography and en-face OCT in paracentral acute middle maculopathy with perivenular ischemia associated with a central retinal artery occlusion [published online ahead of print, 2021 Feb 23]. J Fr Ophtalmol. 2021;S0181-5512(21)00037-1. https://doi.org/10.1016/j.jfo.2020.06.044
  52. Bakhoum MF, Freund KB, Dolz-Marco R, et al. Paracentral Acute Middle Maculopathy and the Ischemic Cascade Associated With Retinal Vascular Occlusion. Am J Ophthalmol. 2018;195:143-153. https://doi.org/10.1016/j.ajo.2018.07.031
  53. Nemiroff J, Kuehlewein L, Rahimy E, et al. Assessing Deep Retinal Capillary Ischemia in Paracentral Acute Middle Maculopathy by Optical Coherence Tomography Angiography. Am J Ophthalmol. 2016;162:121-132.e1. https://doi.org/10.1016/j.ajo.2015.10.026
  54. Nemiroff J, Phasukkijwatana N, Sarraf D. Optical Coherence Tomography Angiography of Deep Capillary Ischemia. Dev Ophthalmol. 2016;56:139-145. https://doi.org/10.1159/000442806
  55. Iafe NA, Onclinx T, Tsui I, Sarraf D. Paracentral acute middle maculopathy and deep retinal capillary plexus infarction secondary to reperfused central retinal artery occlusion. Retin Cases Brief Rep. 2017;11 Suppl 1: S90-S93. https://doi.org/10.1097/ICB.0000000000000424
  56. Sellam A, Glacet-Bernard A, Coscas F, Souied EH. [Abnormal retinal artery perfusion and optical coherence tomography angiography (In French)]. J Fr Ophtalmol. 2017;40(5):353-362. https://doi.org/10.1016/j.jfo.2016.12.017
  57. Phasukkijwatana N, Rahimi M, Iafe N, Sarraf D. Central Retinal Vein Occlusion and Paracentral Acute Middle Maculopathy Diagnosed with En Face Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina. 2016;47(9):862-864. https://doi.org/10.3928/23258160-20160901-10
  58. Grewal DS, Polascik BA, Kelly MP, Fekrat S. Widefield en face optical coherence tomography to quantify the extent of paracentral acute middle maculopathy. Can J Ophthalmol. 2017;52(3): e85-e88. https://doi.org/10.1016/j.jcjo.2016.11.028
  59. Casalino G, Williams M, McAvoy C, et al. Optical coherence tomography angiography in paracentral acute middle maculopathy secondary to central retinal vein occlusion. Eye (Lond). 2016;30(6):888-893. https://doi.org/10.1038/eye.2016.57
  60. Spaide RF, Fujimoto JG, Waheed NK. Image artifacts in optical coherence tomography angiography. Retina. 2015;35(11):2163-2180. https://doi.org/10.1097/IAE.0000000000000765
  61. Casalino G, Coppola M, Earley O, et al. Paracentral acute middle maculopathy as a cause of unexplained visual loss in central retinal vein occlusion. Saudi J Ophthalmol. 2019;33(2):168-171. https://doi.org/10.1016/j.sjopt.2018.07.005
  62. Groeneveld E. Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery: comment. Clin Exp Ophthalmol. 2018;46(5): 576-577. https://doi.org/10.1111/ceo.13117
  63. Hooshmand J, Moore P, McKay D, Vote BJ. Paracentral acute middle maculopathy associated with severe vision loss following vitrectomy for vitreous haemorrhage. Clin Exp Ophthalmol. 2018;46(6):706-708. https://doi.org/10.1111/ceo.13151
  64. O’Day R, Harper CA, Wickremasinghe SS. Central retinal artery occlusion showing features of paracentral acute middle maculopathy following uncomplicated pterygium surgery. Clin Exp Ophthalmol. 2019;47(1):141-143. https://doi.org/10.1111/ceo.13353
  65. Pham C, Boo A, Chew SKH, Okada M. Paracentral acute middle maculopathy in a young patient following routine phacoemulsification surgery. Clin Exp Ophthalmol. 2019;47(9):1206-1209. https://doi.org/10.1111/ceo.13597
  66. Maltsev DS, Kulikov AN, Burnasheva MA, Chhablani J. Prevalence of resolved paracentral acute middle maculopathy lesions in fellow eyes of patients with unilateral retinal vein occlusion. Acta Ophthalmol. 2020;98(1): e22-e28. https://doi.org/10.1111/aos.14196
  67. Burnasheva MA, Maltsev DS, Kulikov AN, Sherbakova KA, Barsukov AV. Association of Chronic Paracentral Acute Middle Maculopathy Lesions with Hypertension. Ophthalmol Retina. 2020;4(5):504-509. https://doi.org/10.1016/j.oret.2019.12.001
  68. Casalino G, Williams M, McAvoy C, et al. Optical coherence tomography angiography in paracentral acute middle maculopathy secondary to central retinal vein occlusion. Eye (Lond). 2016;30(6):888-893. https://doi.org/10.1038/eye.2016.57
  69. Wu JG, Huang ZY, Zhou WY. Paracentral Acute Middle Maculopathy Treated with Acupuncture: A Case Report. Chin J Integr Med. 2020;26(9):709-712. https://doi.org/10.1007/s11655-019-3155-y.
  70. Özmert E, Arslan U. Management of Deep Retinal Capillary Ischemia by Electromagnetic Stimulation and Platelet-Rich Plasma: Preliminary Clinical Results. Adv Ther. 2019;36(9):2273-2286. https://doi.org/10.1007/s12325-019-01040-2
  71. Arrigo A, Knutsson KA, Rajabjan F, et al. Combined central retinal vein occlusion and branch retinal artery occlusion treated with intravitreal dexamethasone implant: A case report. Eur J Ophthalmol. 2020;1120672120909181. https://doi.org/10.1177/1120672120909181

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. A case of arteriolar paracentral acute middle maculopathy: a — color fundus photography shows normal fundus appearance, however the light sensitivity in the superior macula is decreased; b — cross-sectional optical coherence tomography scan shows a long span of the inner nuclear layer fading (the position of the scan corresponds to the black line in d); c — infrared scanning laser ophthalmoscopy confirms the existence of a hyporeflective area in the upper part of the macula corresponding to the zone of paracentral acute middle maculopathy; d — structural en face projection of optical coherence tomography in the deep vascular complex slab shows the distinct area of arteriolar paracentral acute middle maculopathy in the superior macula; e — optical coherence tomography angiography projection of the deep vascular complex slab shows moderate hypoperfusion in the superior macular part corresponding to the area occupied by the arteriolar paracentral acute middle maculopathy lesion

Download (905KB)
Indexing metadata
3. Fig. 2. A case of fern-like perivenular paracentral acute middle maculopathy: a — color fundus photography demonstrates barely visible retinal whitening and as well as hemorrhages in various retinal layers; b — cross-sectional optical coherence tomography scan shows areas of hyperreflectivity of the inner nuclear layer; c — structural en face optical coherence tomography projection of the deep vascular plexus slab shows multiple perivenular areas of paracentral acute middle maculopathy; d — fluorescein angiography shows preserved retinal profusion and some intraretinal hemorrhages; e — infrared scanning laser ophthalmoscopy shows multiple hyporeflective areas corresponding to the zones of deep retinal ischemia

Download (875KB)
Indexing metadata

Copyright (c) 2020 Burnasheva M.A., Kulikov A.N., Maltsev D.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies