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Background: To report a rare case of pulmonary and ocular complications with visual loss due to bilateral Purtscher-like retinopathy and paracentral acute middle maculopathy (PAMM) following a hyaluronic acid (HA) filler injection to the breast. Systemic and visual recovery was attained following corticosteroid therapy., Case Presentation: A 27-year-old lady presented with painless blurring of vision in both eyes for 2 weeks following hyaluronic acid breast filler injections by a non-medical practitioner. She was initially admitted to the medical ward for diffuse alveolar haemorrhage and altered sensorium. The presenting visual acuity was counting fingers in both eyes. Bilateral dilated fundus examination showed hyperaemic discs, concentric rim of retinal whitening around macula with patches of polygonal-shaped retinal whitening, generalised cotton-wool spots, tortuous veins, and flame-shaped haemorrhages. Spectral-domain optical coherence tomography (SD-OCT) macula revealed hyper-reflective bands at the inner nuclear layer (INL). Fluorescein angiography demonstrated hot discs, delayed arm-to-retina time, arterial filling, and arterio-venous transit time with staining of the vessels at the posterior pole. She was managed with a tapering dose of systemic corticosteroids. The visual acuity improved to 6/12 over 8 weeks with significant anatomical and functional improvement. Dilated fundus examination showed resolution of initial funduscopy findings. The hyper-reflective bands on the OCT had resolved with subsequent thinning of the INL and disorganisation of retinal inner layers., Conclusion: Filler injections are in increasing demand and are frequently being performed by non-medical practitioners. Visual loss from non-facial HA fillers is rare. Inadvertent entry of HA into a blood vessel may potentially cause systemic and sight-threatening ocular complications. Good anatomical knowledge and proper injection technique are vital in preventing this unfortunate sequela. There are limited reports on successful visual recovery following various treatment approaches and we hope this case provides valuable insights., (© 2023. The Author(s).)

Background and Objectives: Spectral-domain optical coherence tomography (SD-OCT) is a valuable tool for non-invasive imaging of the retina, allowing the discovery and visualization of localized lesions, the presence of which is associated with eye diseases. The present study introduces X-Net, a weakly supervised deep-learning framework for automated segmentation of paracentral acute middle maculopathy (PAMM) lesions in retinal SD-OCT images. Despite recent advances in the development of automatic methods for clinical analysis of OCT scans, there remains a scarcity of studies focusing on the automated detection of small retinal focal lesions. Additionally, most existing solutions depend on supervised learning, which can be time-consuming and require extensive image labeling, whereas X-Net offers a solution to these challenges. As far as we can determine, no prior study has addressed the segmentation of PAMM lesions in SD-OCT images., Methods: This study leverages 133 SD-OCT retinal images, each containing instances of paracentral acute middle maculopathy lesions. A team of eye experts annotated the PAMM lesions in these images using bounding boxes. Then, labeled data were used to train a U-Net that performs pre-segmentation, producing region labels of pixel-level accuracy. To attain a highly-accurate final segmentation, we introduced X-Net, a novel neural network made up of a master and a slave U-Net. During training, it takes the expert annotated, and pixel-level pre-segment annotated images and employs sophisticated strategies to ensure the highest segmentation accuracy., Results: The proposed method was rigorously evaluated on clinical retinal images excluded from training and achieved an accuracy of 99% with a high level of similarity between the automatic segmentation and expert annotation, as demonstrated by a mean Intersection-over-Union of 0.8. Alternative methods were tested on the same data. Single-stage neural networks proved insufficient for achieving satisfactory results, confirming that more advanced solutions, such as the proposed method, are necessary. We also found that X-Net using Attention U-net for both the pre-segmentation and X-Net arms for the final segmentation shows comparable performance to the proposed method, suggesting that the proposed approach remains a viable solution even when implemented with variants of the classic U-Net., Conclusions: The proposed method exhibits reasonably high performance, validated through quantitative and qualitative evaluations. Medical eye specialists have also verified its validity and accuracy. Thus, it could be a viable tool in the clinical assessment of the retina. Additionally, the demonstrated approach for annotating the training set has proven to be effective in reducing the expert workload., Competing Interests: Declaration of Competing Interest Authors have no competing interests., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: To analyze the imaging characteristics and the clinical course of patients showing concomitant paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) post-blunt trauma., Methods: PAMM and AMN lesions post-blunt trauma diagnosed on enhanced depth imaging optical coherence tomography (EDI-OCT) were recruited for the study., Results: : Thirteen eyes of 13 individuals with a history of blunt trauma were included in the study, of whom 11 (85%) were males. Mean age of the patients was 33.62 (range 16-67) years. Mean visual acuity at presentation and the last visit was 1.67 log of minimum angle of resolution (logMAR) and 0.82 logMAR, respectively. Mean interval between trauma and imaging was 5.08 (range 1-15) days. All patients had unilateral involvement, with the right eye being involved in 10 patients (77%). All patients had concomitant PAMM and AMN lesions., Conclusion: : Presence of coincident PAMM and AMN suggests a common pathophysiologic etiology, but the description of concomitant PAMM and AMN in the setting of blunt trauma to eye is hitherto unreported. Identifying AMN in a setting of PAMM requires meticulous examination of the OCT and OCTA images. It can be a cause of suboptimal visual recovery in such eyes., Competing Interests: None

We present a 65-year-old woman who developed sudden and severe vision loss in her left eye one day after the administration of the second dose of COVID vaccine. The best corrected visual acuity in this eye was 1/10. Diffuse paracentral acute middle maculopathy was detected on spectral domain optical coherence tomography (OCT). OCT angiography images revealed concurrent vascular flow defects consistent with acute macular neuroretinopathy in the deep retinal capillary plexus and choriocapillaris layers. At the end of the six-month follow-up, there was no improvement in visual acuity, and atrophy and thinning developed in all layers of the retina., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by the Turkish Ophthalmological Association / Turkish Journal of Ophthalmology published by Galenos Publishing House.)

Background: To report a case of paracentral acute middle maculopathy (PAMM) that progressed to central retinal artery occlusion (CRAO) on spectral domain-optical coherence tomography (SD-OCT)., Case Presentation: A 63-year-old male presented with a paracentral scotoma that began several days ago. His past medical history consisted of third-degree atrioventricular heart block requiring a pacemaker. Giant cell arteritis was unlikely given the patient's labs, demographics and review of systems. SD-OCT revealed a characteristic hyperreflective band in the inner nuclear layer consistent with PAMM in his left eye. Fluorescein angiography was obtained and was unremarkable. Five days later, the patient developed no light perception in the left eye. SD-OCT showed a diffuse inner retinal hyperreflectivity consistent with CRAO., Conclusion: PAMM can be a harbinger event for complete CRAO. Complete stroke evaluation should be performed to prevent a cerebrovascular event or progression to complete blindness in the involved eye., (© 2023. The Author(s).)

An ophthalmology consultation was requested for a 29-year-old woman complaining of visual field defects. The patient had presented to the emergency department with cough and high fever one day earlier. Chest computed tomography demonstrated pneumonia and two severe acute respiratory syndrome coronavirus 2 polymerase chain reaction tests were positive. The patient had undergone renal transplantation 11 years ago due to glomerulonephritis. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/30 in the left eye. Fluorescein angiography showed macular hypoperfusion, and optical coherence tomography (OCT) showed hyperreflectivity in the inner nuclear, outer plexiform, and outer nuclear layers, as well as discontinuity of the ellipsoid zone. Perimetry confirmed bilateral central scotoma. Levels of D-dimer and fibrinogen were 0.86 g/mL and 435.6 g/mL, respectively. The patient was diagnosed as having concurrent acute macular neuroretinopathy and paracentral acute middle maculopathy and was given low-molecular-weight heparin treatment for one month. Her BCVA improved to 20/20 in both eyes, and regression was observed in the retinal findings, hyperreflectivity and ellipsoid zone disruption on OCT, and scotoma in perimetry. Inflammation, thrombosis, and glial involvement may play a role in the pathogenesis of retinal microvascular impairment in COVID-19., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by Turkish Ophthalmological Association | Turkish Journal of Ophthalmology, published by Galenos Publishing House.)

Purpose: To describe a case of interferon-beta retinopathy associated with paracentral acute middle maculopathy., Case Report: A 15-year-old girl with Epstein-Barr virus-positive advanced nasopharyngeal carcinoma WAS REFERRED with reduced visual acuity. Multimodal imaging findings, including optical coherence tomography angiography, at presentation and evolution following cessation of interferon therapy are presented., Conclusion: The presentation of paracentral acute middle maculopathy in this patient supports the presumed ischaemic pathogenesis in interferon retinopathy. The imaging findings provide evidence of deep capillary plexus involvement in interferon retinopathy with evolution to permanent structural damage within the inner nuclear layer.

Background: Growing evidence suggests an association between the infection from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and eye disorders. The aim of this review was to analyze the clinical presentation and diagnostic features of acute macular neuroretinopathy (AMN) and paracentral acute middle maculopathy (PAMM) associated with COVID-19 infection. The features are then compared with previous reports regarding these retinal disorders, to recognize possible specific characteristics and to assess the role of multimodal ophthalmic imaging., Summary: A literature search was performed by consulting PubMed, Scopus, and Embase. The following terms were searched: "(COVID-19 OR SARS-CoV-2 OR coronavirus) AND ([acute macular neuroretinopathy] OR [paracentral acute middle maculopathy])." Inclusion criteria were as follows: (1) publication date from January 31, 2020 to January 31, 2022; (2) English language; (3) original research or case report; (4) free full-text availability.Optical coherence tomography (OCT) findings in AMN patients were hyper-reflectivity (HR) of the outer plexiform layer, of the outer nuclear layer, and ellipsoid or interdigitation zones (EZ and IZ, respectively) disruption. In most cases, the presence of HR and EZ/IZ abnormalities resulted combined. When performed, OCT angiography (OCTA) identified attenuation of signal of the deep capillary plexus (DCP). The most common OCT finding in PAMM was an alteration of the inner nuclear layer, associated with other areas of HR, while no signs of EZ/IZ disruption were detected. When performed, OCTA showed the attenuation of signal of both the DCP and the superficial capillary plexus., Key Messages: In this review, we reported a case series of AMN and PAMM in patients with a previous or concomitant infection from SARS-CoV-2. The microvascular changes in these cases are highlighted by the OCTA scans. Even if we are far from the determination of a direct link between COVID-19 and these retinal disorders, we could hypothesize that the vascular alterations associated with SARS-CoV-2 infection could be a possible risk factor for both AMN and PAMM., (© 2023 S. Karger AG, Basel.)

Purpose: To evaluate with optical coherence tomography angiography the status of the choriocapillaris in the eyes of patients with resolved paracentral acute middle maculopathy (PAMM)., Methods: Nine patients with unilateral resolved PAMM, 14 age-matched healthy individuals, and 16 age-matched patients with unilateral retinal vein occlusion (RVO) were included. The choriocapillaris flow area, and the number of choriocapillaris flow voids was compared between the eyes of healthy individuals, both eyes of the PAMM patients, and the fellow eyes of unilateral RVO patients., Results: The number of choriocapillaris flow voids in the unaffected eyes of PAMM patients was statistically significantly higher than in the eyes of healthy individuals (p < 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.022). The choriocapillaris flow area in the unaffected eyes of PAMM patients was statistically significantly lower than in the eyes of healthy individuals (p < 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.019). There was no difference in the status of the choriocapillaris between two eyes of PAMM patients., Conclusion: Eyes of patients with resolved PAMM have a substantial decrease of choriocapillaris perfusion.

Background: Since its emergence in Wuhan, China, COVID-19 has disseminated across many other countries worldwide. In this report, we firstly presented a patient with mild COVID-19 disease who developed paracentral acute middle maculopathy (PAMM) due to CRAO., Case Presentation: A 54-year-old male patient who reported a contact with a COVID-19 patient applied to the hospital and tested positive for SARS-CoV-2 by polimerase chain reaction testing. He had no significant past medical history. Chest computed tomography was not notable. He had a mild COVID-19 course during hospitalization. Two weeks following COVID-19 diagnosis, he reported profund vision loss (counting fingers) in his right eye where central retinal artery occlusion (CRAO) was detected on fundoscopic examination. Coagulation profile was within normal limits. Hypercoagulable work up was also not notable. Treatment was given for CRAO. Visual acuity was counting fingers at 30 cm. Five days following treatment. Optical coherence tomography analysis showed increased diffuse reflectance and thickening at the level of inner nuclear layer consistent with PAMM. Fluorescein angiography illustrated no perfusion defect., Conclusion: This is the first case that reports PAMM in the setting of CRAO following COVID-19 diagnosis. Viral induced microangiopathy may involve in the development of CRAO in our patient without a hypercoagulable state and additional risk factors. Physicians should be vigilant to seek for retinal evaluation in patients with significant visual loss even after a mild COVID-19 history.

Objective: To evaluate structural and morphological changes in the retina using optical coherence tomography (OCT) in patients with thrombotic microangiopathy (TMA) associated with atypical hemolytic-uremic syndrome (aHUS)., Material and Methods: The study analyzed OCT data of 14 patients (28 eyes) with an established diagnosis of aHUS including such indicators as central retinal thickness (CRT), thickness of the retinal nerve fiver layer (RNFL), ganglion cell layer (GCL), retinal pigment epithelium (RPE), etc., Results: Patients with aHUS were noted to have an increase in CRT, paracentral acute middle maculopathy in the form of a hyperreflective defect primarily of the inner nuclear layer of paracentral localization, as well as disorganization of the RPE, which was observed statistically significantly more often compared to healthy persons ( p =0.0001, p =0.001 and p =0.009 respectively). In the subgroup with thrombotic retinopathy (6 people) a statistically significant increase in CRT and peripapillary RNFL was found ( p =0.004 and p =0.001) compared to patients without thrombotic retinopathy, as well as the presence of paracentral acute middle maculopathy and transudative macular retinoschisis ( p =0.0001 and p =0.004). A statistically significant thinning of the peripapillary RNFL was revealed ( p =0.0001) in the subgroup with symptoms of Purtscher-like retinopathy (PLR) found retrospectively (4 people) compared to patients without retrospective PLR symptoms. A statistically significant decrease in CRT was revealed ( p =0.018) in the subgroup of patients receiving systemic therapy with eculizumab (5 people) compared with patients not receiving this therapy. Statistically significant correlations were recorded between the studied OCT indicators, laboratory indicators, and the level of systolic blood pressure ( p <0.05)., Conclusion: According to OCT, paracentral acute middle maculopathy is a biomarker of thrombotic retinopathy and the activity of systemic TMA associated with aHUS. Arterial hypertension is an additional aggravating factor in the development of paracentral acute middle maculopathy and transudative macular retinoschisis. Targeted therapy with eculizumab leads to an effective decrease in CRT, which is potentially associated with regression of ischemic edema. The outcome of PLR involves thinning of peripapillary RNFL.

Introduction: Paracentral acute middle maculopathy (PAMM) is a tomographic finding of a retinal occlusive vascular disorders with different aetiologies. Despite the well documented triple association among hyper-homocysteine, retinal vein occlusion and PAMM, up to date no reports exist on the development of PAMM in young patients affected by ulcerative colitis (UC)., Case Description: A multimodal imaging study, including fundus photographs, optical coherence tomography (OCT) B-scans, OCT angiography (OCT-A) and fluorescein and indocyanine green angiography, was performed in a 32-years-old male complaining of acute-onset paracentral scotoma in the right eye. Fundus images demonstrated the typical dark gray area of retinal capillary ischemia, corresponding on OCT B-scans to the hyper-reflective plaques in the INL, and consistent with PAMM lesions.The deep capillary plexus (DCP) was normal on OCT-A. Fluorescein angiography revealed a concurrent branch retinal vein preocclusion and showed capillary drop out parafoveally. Patient's anamnesis was negative except for a 15-years history of UC and use of acetylsalicylic acid (ASS). At the time of presentation, UC was quiescent, but new blood tests revealed concomitant high values of homocysteinemia requiring oral vitamin B12 and folate supplementation. Two months later PAMM lesions had disappeared on OCT B-scans and a retinal thinning at the level of the inner nuclear layer (INL) was visible. The DCP on OCT-A remained unchanged without any sign of capillary ischemia., Conclusions: Although no definitive evidence directly links UC with PAMM, the latter should be suspected in young patients affected by IBD with coexisting hyper-homocysteinemia and unexplained visual symptoms.

We aim to present a case with bilateral sequential paracentral acute middle maculopathy (PAMM). A 57-year-old man presented with paracentral scotoma in the left eye. The patient's multimodal imaging findings were consistent with PAMM in the left eye. Extensive systemic work-up revealed hypertension and a history of cerebrovascular event. One year after initial presentation, the patient had a subsequent decrease in visual acuity in the right eye and developed optical coherence tomography findings consistent with PAMM, whereas the left eye showed resolved PAMM findings. Although rare, PAMM can occur bilaterally. Clinicians should monitor unilateral PAMM patients with systemic vasculopathy for involvement in the fellow eye.

Background: We report one case of rare acute macular neuroretinopathy (AMN) in an elderly patient with hypertension and one case of common paracentral acute middle maculopathy (PAMM) in a patient with diabetes mellitus to illustrate the difference between the two diseases., Case Presentation: This report describes two cases, one involving AMN and the other PAMM. The first patient was a 70-year-old man complaining of blurred vision for 3 days. He was examined with fundus photography, optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT); a diagnosis of AMN was established. The second patient was a 50-year-old woman who complained of decreased vision during the past month. She had had diabetes mellitus for 6 years. From the ophthalmic imaging examination, the patient was diagnosed with PAMM and non-proliferative diabetic retinopathy (NPDR). Both patients were treated with drugs for improving microcirculation and neurotrophic drugs; however, there was no significant improvement in visual acuity., Conclusions: AMN is more common in young patients and is rarely observed in elderly patients with systemic diseases. The OCTA examination has an auxiliary diagnostic value for deep retinal capillary network ischaemia. Meanwhile, OCT examination has important imaging value in differentiating AMN from PAMM and can help avoid missed diagnoses., (© 2021. The Author(s).)

Purpose: To investigate the structural and microvascular changes in the retina and choriocapillaris in patients with sickle cell disease (SCD) demonstrating acute vision loss and acute macular neuroretinopathy (AMN) or paracentral acute middle maculopathy (PAMM) using multimodal imaging including OCT and OCT angiography (OCTA)., Design: Retrospective case series., Participants: Four hemoglobin SS (HbSS) or hemoglobin SC (HbSC) patients who demonstrated vision loss attributed to AMN (n = 2) or PAMM (n = 2)., Methods: Clinical characteristics including best-corrected visual acuity and multimodal imaging features from fundus photography, fluorescein angiography, OCT, and OCTA were analyzed., Main Outcome Measures: Longitudinal changes in the structure and microvasculature of the retina and choriocapillaris were examined., Results: In 2 patients with AMN, characteristic hyperreflective changes were observed in the outer nuclear layer with involvement of the ellipsoid and interdigitation zones. In 1 patient, the lesion was located in the foveal avascular zone, and only flow deficits in the choriocapillaris were noted. In the second patient, no flow loss was observed in the superficial capillary plexus (SCP) corresponding to the lesion, but flow loss was seen in the deep capillary plexus (DCP) and choriocapillaris. At the respective 1-year and 4-month follow-up examinations, the hyperreflectivities improved with no ensuing retinal atrophy. Deep capillary plexus and choriocapillaris flow also improved. Of the 2 patients with PAMM, 1 had PAMM in association with branch retinal arteriolar occlusions. In both patients, a hyperreflective band involving the inner plexiform, inner nuclear, and outer plexiform layers was seen in or adjacent to areas of prior macular thinning. These areas corresponded to flow deficits in both the SCP and DCP. At the respective 1-month and 1-year follow-up examinations, the hyperreflective band improved with ensuing atrophy of the middle retinal layers. OCT angiography demonstrated worsening of flow deficits in the corresponding SCP and DCP., Conclusions: To the best of our knowledge, this is the first report of AMN and the largest case series of AMN or PAMM in SCD to date. Paracentral acute middle maculopathy may precede macular thinning commonly observed in SCD. OCT angiography is a useful tool to demonstrate associated microvascular changes in AMN and PAMM in SCD., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Paracentral acute middle maculopathy (PAMM) is a recently identified spectral-domain optical coherence tomography (SD-OCT) finding characterized by a hyper-reflective band spanning the inner nuclear layer (INL), which typically evolves to INL atrophy in later stages. Typical clinical features include the sudden onset of one or multiple paracentral scotomas, normal or mild reduction in visual acuity, and a normal fundus appearance or a fundus with a deep grayish lesion. Although its pathophysiology is not yet fully understood, ischemia at the level of the intermediate and deep capillary plexa has been demonstrated to play a major role. Since its first description, an increasing number of publications on PAMM have been published in ophthalmology scientific journals. The purpose of this study is to provide a review of the current literature on PAMM.

Purpose: To study the prevalence of resolved paracentral acute middle maculopathy (PAMM) lesions in fellow eyes of patients with unilateral retinal vein occlusion (RVO) and eyes of healthy individuals., Methods: This case-control observational study took place in a referral university medical centre. Forty-five (17 males, 28 females, 64.7 ± 10.8 years) patients with branch retinal vein occlusion (BRVO), 21 (17 males, 4 females, 68.8 ± 11.2 years) patients with central retinal vein occlusion (CRVO) and 57 healthy individuals (25 males, 32 females, 67.4 ± 10.5 years) were included. Presence of resolved PAMM lesions was evaluated by reviewing cross-sectional scans of 8-mm optical coherence tomography angiography protocol. Resolved PAMM lesion was defined as inner nuclear layer thinning with outer plexiform layer elevation., Results: Resolved PAMM lesions were found in 32/45 (71.1%) and 15/21 (71.4%) of BRVO and CRVO patients, respectively. In healthy volunteers, resolved PAMM lesions were found in 11/57 (19.3%) individuals with bilateral involvement in 8 individuals (72.7%). RVO patients demonstrated the presence of resolved PAMM lesions in fellow eye significantly more frequently than healthy individuals (odds ratio (OR) 10.6, p < 0.001, 95% CI 4.5-24.6). OR for the presence of large resolved PAMM lesions in BRVO patients and CRVO patients versus healthy individual was 12.1 (p = 0.02, 95% CI 1.5-100.9) and 22.4 (p = 0.005, 95% CI 2.5-200.6), respectively., Conclusion: Resolved PAMM lesions defined as inner nuclear layer thinning associated with outer plexiform layer elevation are highly prevalent in fellow eyes of patients with unilateral RVO. Resolved PAMM lesions may have an association with RVO., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Paracentral acute middle maculopathy (PAMM) is a rare disease affecting middle layers of the central retina that is seen as a focal hyperreflective band-like lesion on optical coherence tomography. Paracentral acute middle maculopathy is associated mainly with vascular diseases. Optical coherence tomography angiography (OCTA) findings confirm the ischemic nature of paracentral acute middle maculopathy.

The authors present the use of prostaglandin E1 (PGE1) for the treatment of an acute paracentral acute middle maculopathy (PAMM). A 78-year-old white female was seen with a sudden loss of vision in her left eye (OS) to 20/200 noted upon awakening. The right eye (OD) saw 20/20. A complete eye exam was done and an ocular coherent tomography revealed retinal thickening and a whitening of the inner nuclear layer in the area of the macula OS. A diagnosis of PAMM in the OS was made. Treatment was immediately started with 70 μg of PGE1 administered over 1.5 hours in the form of a skin cream. A volume of 3.5 cc of skin cream was applied in divided doses to the inner surface of the forearm, rubbed into the skin and allowed to dry. The same 70 μg of PGE1 in 3.5 cc of skin cream was repeated once the next morning. The patient began to see better the second day of treatment with a final visual acuity of 20/20. The OD was unchanged. After 14 months she was stable with no further treatment. PAMM is an ischemic process of the inner retina. PGE1, a potent vasodilator of the microcirculation, when given immediately seemed to be useful in restoring vision in this form of retinal ischemia. Treatment was immediately started with PGE1 in the form of a skin cream with visual improvement. The authors normally use PGE1 intravenously for acute ocular ischemia and would have preferred that here. Intravenous PGE1 was not available and was substituted with the skin cream of PGE1 that worked well for the patient.

Paracentral acute middle maculopathy (PAMM) is identified by the occurrence of an inner nuclear layer (INL) hyperreflective band on optical coherence tomography (OCT), which was subsequently accompanied by INL atrophy. A multitude of systemic diseases and vasculopathy risk factors have been linked to PAMM. PAMM, which has been associated with infection with Coronavirus disease 2019(COVID 19), may indicate post-infectious complications. By influencing vascular endothelial cells, COVID-19 infection can induce an inflammatory and procoagulatory state, resulting in vascular thromboembolic complications, although the precise mechanisms underlying these complications remain unknown. Thus, the present review explores and discusses about paracentral acute middle maculopathy, its diagnosis and treatment and adds a note on its implications after the outbreak of COVID 19. [ABSTRACT FROM AUTHOR]

Purpose: To report the prevalence, clinical characteristics and risk factors for paracentral acute middle maculopathy (PAMM) following acute primary angle closure (APAC) and acute primary angle closure glaucoma (APACG).Methods: This retrospective study consecutively recruited patients diagnosed with APAC or APACG. Based on the spectral domain optical coherence tomography characteristics, PAMM eyes were divided into three stages. Characteristics of different stages such as the time from symptoms to treatment (TST), retinal thickness and BCVA improvement were analyzed. The risk factors of PAMM were evaluated by binary logistic regression models.Results: A total of 781 eyes of 781 APAC or APACG patients were included, and PAMM was found in 22 (2.9%) of them. Stage III eyes had a significantly longer TST than stage I eyes (P = 0.008) while exhibiting significantly thinner retinal thicknesses (P < 0.0001). The BCVA improvement was significantly worse in the eyes treated in stage III than in those treated in stage I (P = 0.008). Older age, longer axial length and without type 2 diabetes were associated with a lower risk of incident PAMM (OR = 0.95, P = 0.028; OR = 0.52, P = 0.019; OR = 3.92, P = 0.022).Conclusion: PAMM can be secondary to APAC or APACG at a rate of 2.9%. Different visual outcomes were observed in patients who received the intervention at different stages of PAMM. Younger patients with a shorter axial length and type 2 diabetes were found to be more susceptible to PAMM. [ABSTRACT FROM AUTHOR]

Purpose: The association between paracentral acute middle maculopathy (PAMM) and visual acuity in patients with central retinal artery occlusion (CRAO) is still unclear. The present study investigated the visual acuity of CRAO patients with and without PAMM. Methods: CRAO patients with PAMM or without PAMM were included. Optical coherence tomography angiography (OCT-A) was used to record the macular retinal thickness and density of shallow and deep vessels. The Best-corrected visual acuity (BCVA) was converted to a logarithm of the minimum angle of resolution (LogMAR) for statistical analysis. Results: There were 34 CRAO patients with PAMM (43.13%), other 30 CRAO patients without PAMM (46.87%). Compared with the no-PAMM group, PAMM group had better LogMAR BCVA (1.48 (0.49, 1.85) Vs. 1.85 (1.70, 1.96), P < 0.01). There was also a significant difference in retinal thickness of the central macular sulcus (328.00 (304.50–332.25) Vs. 352.50 (311.75–420.50), P = 0.01). A significant correlation between LogMAR BCVA and macular retinal thickness was found (r = 0.42; P < 0.01). Conclusion: CRAO patients with PAMM had significantly better visual acuity and less macular edema. OCT-A can be used to distinguish different levels of damage due to CRAO. [ABSTRACT FROM AUTHOR]

Paracentral acute middle maculopathy (PAMM) is an optical coherence tomography (OCT) finding secondary to retinal ischemia. In this presentation, we describe the diagnosis of hereditary thrombophilia caused by multiple gene mutation, based on the PAMM finding on OCT, in a patient with no known disease who presented with unilateral scotoma. Hematological evaluation has an important role in young PAMM cases without systemic and ocular disease. Patients with thrombophilic mutations may be first recognized with ocular symptoms by ophthalmologists. It may be life-saving to reveal the risks of patients such as cardiovascular disease and thromboembolism at an early age. [ABSTRACT FROM AUTHOR]

Retinal complications in patients with inflammatory optic neuritis (ON) are generally related to post-infectious neuroretinitis and are considered uncommon in autoimmune/demyelinating ON, whether isolated or caused by multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). More recently, however, cases with retinal complications have been reported in subjects positive for myelin oligodendrocyte glycoprotein (MOG) antibodies. We report a 53-year-old woman presenting with severe bilateral ON associated with a focal area of paracentral acute middle maculopathy (PAMM) in one eye. Visual loss recovered remarkably after high-dose intravenous corticosteroid treatment and plasmapheresis, but the PAMM lesion remained visible on both optical coherence tomography and angiography as an ischaemic lesion affecting the middle layers of the retina. The report emphasises the possible occurrence of retinal vascular complications in MOG–related optic neuritis, an important addition to the diagnosis of, and possible differentiation from, MS–related or NMOSD–related ON. [ABSTRACT FROM AUTHOR]

We report a case of paracentral acute middle maculopathy (PAMM) in association with coronavirus disease 2019 (COVID-19) vaccination. A 67-year-old male patient presented with a complaint of decreased vision in his right eye (OD) three days after receiving the Pfizer-BioNTech COVID-19 vaccine. Dilated fundus examination showed a white retinal lesion in the superior parafoveal region and optic disc edema in OD, and fundus autofluorescence (FAF) revealed hypoautofluorescence at the corresponding area. Spectral domain optical coherence tomography (SD-OCT) demonstrated the presence of a hyperreflective band along the inner nuclear layers (INL) and extending from the outer plexiform layer (OPL) to inner plexiform layer (IPL) in OD, SD-OCT was normal in his left eye (OS). Fundus fluorescein angiography (FA) showed hypofluorescence in the superior parafoveal area with late disc leakage in OD and FA was normal in OS. Current case highlights the recent severe acute respiratory syndrome coronavirus - 2 (SARS-CoV-2) vaccine as a possible cause for PAMM as a form of a rare adverse effect. However, further studies should be done to describe any association between COVID-19 vaccination and post-vaccination related retinopathies. [ABSTRACT FROM AUTHOR]

Purpose: To review the demographic and clinical profile of patients developing acute macular neuroretinopathy (AMN) or paracentral acute middle maculopathy (PAMM) after receiving coronavirus disease-2019 (COVID-19) vaccination or infection. Methods: In this review article, the published literature was searched to determine cases developing either AMN or PAMM after COVID-19 vaccinations or infections. Data, including demographic profile, presenting features, symptoms, diagnosis, and clinical outcomes, were extracted from the selected publications. These parameters were compared between the two groups, i.e., patients developing AMN/PAMM either after vaccination or infection. Results: After the literature review, 57 patients developing either AMN (n = 40), PAMM (n = 14), or both (n = 3) after COVID-19 infection (n = 29) or vaccination (n = 28) were included (mean age: 34.9 ± 14.4 years; n = 38; 66.7% females). In 24.6% patients, the diagnosis of COVID-19 infection was preceded by the development of ocular disease. There were no significant differences in the age or gender between the patients developing AMN or PAMM after vaccination or infection (p > 0.13). Among the vaccination group, the highest number of patients developing AMN/PAMM were after the Oxford-AstraZeneca (n = 12; 42.9%). Patients with vaccination had a significantly early onset of AMN/PAMM compared to those with infection (11.5 ± 17.6 days versus 37.8 ± 43.6 days; p = 0.001). Conclusions: Both AMN and PAMM are reported to be associated with COVID-19 infections and in persons receiving vaccination against COVID-19. While COVID-19 infections and vaccinations may have a contributory role, other risk factors such as oral contraceptive pills may also play a role in the development of the disease. [ABSTRACT FROM AUTHOR]

This report describes a case of a newly diagnosed 49-year-old HIV patient, who presented with decreased visual acuity and retinal lesions characterized by ischemia at the level of the deep retinal capillary plexus, documented with optical coherence tomography (OCT), OCT angiography, fluorescein angiography, and visual fields testing. These lesions closely resembled the morphologic and clinical characteristics of late paracentral acute middle maculopathy. The presence of these lesions suggests that HIV microangiopathy can potentially affect both superficial and deep retinal capillary plexuses. [ABSTRACT FROM AUTHOR]

A 75-year-old Caucasian woman presented with sudden-onset multifocal scotomas in her right eye's central vision for 1 day. There were subtle white intraretinal foveal lesions that correlated with patchy inner retinal hyperreflectivity on optical coherence tomography, suggestive of paracentral acute middle maculopathy. Initial cerebrovascular work-up was negative. Review of systems was positive for lethargy and jaw claudication. The sedimentation rate and c-reactive protein were elevated, but platelet count was normal. The patient was started on 60 mg oral prednisone daily and underwent bilateral temporal artery that confirmed the diagnosis of giant cell arteritis. [ABSTRACT FROM AUTHOR]

This report describes a case with paracentral acute middle maculopathy revealing a giant aortic aneurysm. A 41-year-old man presented with unilaterally unexplained sudden vision loss in the left eye. Fundoscopy revealed a slightly pale r -26etinal reflex in the superior retinal hemifield. SDOCT revealed blurred boundaries between retinal segments and prominent edema in the middle retinal layers. OCTA revealed decreased vascular density in the deep capillary plexus. FA showed low arterial circulation mainly in the superior retinal hemifield. Humphrey VFT revealed an inferior altitudinal defect in the left eye, implying a related circulatory disturbance in the corresponding region. A thorough systemic work-up, including a cardiovascular etiological investigation, revealed giant aortic aneurysm in the ascending aorta, necessitating emergency surgery. This report highlights the importance of a systemic etiological investigation in patients with PAMM to rule out any potential cardiovascular issues. [ABSTRACT FROM AUTHOR]

Retinal artery occlusion is usually seen acutely in elderly individuals with systemical disease and results in severe vision loss. It is rare in the pediatric age group. In this case report, we aimed to present a 15-year-old female child diagnosed with left inferior hemiretinal artery occlusion with paracentral acute middle maculopathy (PAMM) secondary to cardiac embolism due to mitral valve disease. A 15-year-old female child presented with sudden and painless vision loss in the left eye. Visual acuity was 1,0 in the right eye and 0.8 in the left eye from the inferior half of the visual field. Anterior segment examination was normal. The fundus examination of the left eye revealed retinal whitening in the superior temporal and superior nasal of the the optic disc, the superior part of macula, the inferior half of macula and the inferior half of the retina, and segmentation in the blood column in the inferior branches of the retinal artery was observed, while the right eye was normal. On optical coherence tomography (OCT), diffuse thickening and hyperreflectivity in the superficial layers and shadowing in the outer layers of the retina were observed in the inferior macula and retina in the left eye. In the superior part of the macula, OCT revealed a characteristic hyperreflective band-like lesion on the inner nuclear layer consistent with PAMM. The patient was diagnosed with left inferior hemiretinal artery occlusion and her treatment was planned. The systemical examination of the patient revealed mitral valve stenosis and insufficiency. When retinal artery occlusion is seen in the pediatric age group, a comprehensive etiological investigation is required. PAMM may be associated with BRAO due to mitral valve disease in a pediatric case. [ABSTRACT FROM AUTHOR]