Paracentral Acute Middle Maculopathy-April 2020

A 62-year-old male patient presented to our clinic with the complaint of paracentral scotoma in the left eye for 1 week. Visual acuity was 10/10 in the right eye and 9/10 in the left eye. Intraocular pressures were 15 mmHg in the right eye and 16 mmHg in the left eye.  Multicolor, infrared reflectance, fundus autofluorescence and OCT images of the left eye are shown below. Coul you diagnose the pathology of the patient’s left eye?

The answer to the question is ‘’Paracentral Acute Middle Maculopathy (PAMM)’’. As a result of the lottery drawn among those who answered the question correctly, Mr. Hakan Koç won this month’s book prize. Congratulations to him.

Patients report sudden onset of paracentral scotomas. On OCT, the acute lesions of PAMM characteristically appear as hyperreflective bands at the level of the INL. A legacy of thinning and atrophy of the affected INL ensues, and is responsible for the permanent paracentral scotomas. PAMM occurs as an isolated phenomenon or as complicating feature of an underlying retinal vasculopathy or systemic disease.



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