Case Report: PDF OnlyPARACENTRAL ACUTE MIDDLE MACULOPATHY IN A CASE OF HIGH-FLOW DIRECT CAROTID CAVERNOUS FISTULAHo, Chi Yun Doreen MBBS*; Yan, Bernard DMedSci, FRACP†; Symons, Robert C. Andrew MBBS, PhD*,‡; Hardy, Thomas G. MBBS, FRANZCO*,‡Author Information *Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia; †Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; and ‡Department of Surgery, Royal Melbourne Hospital, the University of Melbourne, Parkville, Victoria, Australia. Reprint requests: Chi Yun Doreen Ho, MBBS, Centre for Eye Research Australia, East Melbourne, Victoria, Australia; e-mail: [email protected]. None of the authors has any financial/conflicting interests to disclose. Retinal Cases & Brief Reports: March 19, 2020 - Volume - Issue - doi: 10.1097/ICB.0000000000000996 Buy PAP Metrics AbstractIn Brief Purpose: To report a case of paracentral acute middle maculopathy in a patient with high-flow carotid cavernous fistula. Methods: A case report of a 53-year-old male patient who sustained an iatrogenic high-flow carotid cavernous fistula and secondary paracentral acute middle maculopathy. Results: At review 1-week postembolization of the carotid cavernous fistula, there was no significant improvement in visual acuity, tests of optic nerve function, external ophthalmoplegia, and ptosis. Spectral domain optical coherence tomography was performed, which revealed hyperreflectivity of the parafoveal plexiform layers of the right eye with ill-defined margins straddling the inner nuclear layer. Conclusion: We suggest that spectral domain optical coherence tomography be performed in cases of high-flow direct carotid cavernous fistula where the best-corrected visual acuity is reduced out of keeping with other ophthalmic manifestations. A case of paracentral acute middle maculopathy in a high-flow direct carotid cavernous fistula. © 2022 by Ophthalmic Communications Society, Inc.