Institutional members access full text with Ovid®

Share this article on:

An Atypical Case of Paracentral Acute Middle Maculopathy

Haskes, Cheryl OD; Santapaola, Shannon OD, FAAO; Zinn, Jordan OD

doi: 10.1097/OPX.0000000000001087
Case Reports

PURPOSE: This is a case presentation of paracentral acute middle maculopathy in a 33-year-old white man with borderline hyperlipidemia. Paracentral acute middle maculopathy was originally thought to be a variant of acute macular neuroretinopathy; however, it is now generally accepted that these two conditions are separate disease entities. The etiology, evolution, and pathophysiology of acute macular neuroretinopathy and paracentral acute middle maculopathy are discussed, as well as current diagnostic techniques.

CASE REPORT: A 33-year-old white man with borderline hyperlipidemia presented with an acute, small paracentral scotoma involving the left eye. Clinical examination revealed a small wedge-shaped retinal lesion that corresponded to scotoma. Spectral domain–optical coherence tomography of the lesion demonstrated irregularity in the middle retina, whereas fluorescein angiography showed subtle hypofluorescence of the lesion. Spectral domain–optical coherence tomography was facilitated in monitoring retinal changes as the patient continued to have a persistent scotoma despite resolution of the retinal lesion.

CONCLUSIONS: Clinically, acute macular neuroretinopathy and paracentral acute middle maculopathy present in very similar fashions with localized scotomas, blurry vision, and subtle retinal lesions that can be difficult to discern funduscopically. At this time, there is no ocular treatment for either condition, but observation and patient education regarding possibly persistent scotomas are necessary. This atypical case highlights paracentral acute middle maculopathy in a relatively young man with a systemic history significant only for borderline hyperlipidemia. Eye care providers should be familiar with acute macular neuroretinopathy and paracentral acute middle maculopathy to enable them to perform appropriate diagnostic testing and to identify patients who require a systemic disease evaluation.

Connecticut Veterans Affairs Medical Centers, West Haven, Connecticut (all authors)

Submitted: September 2, 2016

Accepted: April 25, 2017

Published Online: June 21, 2017

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions: Writing – Original Draft: CH, SS, JZ; Writing – Review & Editing: CH, SS, JZ.

Corresponding Author: Cheryl Haskes VA Medical Center–Eye Clinic 555 Willard Ave Newington, CT 06111 e-mail: cheryl.haskes@va.gov

© 2017 American Academy of Optometry