Xuejing Chen1, Ehsan Rahimy2, Robert C Sergott2, Renata P Nunes3, Eduardo C Souza3, Netan Choudhry4, Nathan E Cutler2, Samuel K S Houston2, Marion R Munk5, Amani A Fawzi5, Sonia Mehta2, Jean-Pierre Hubschman6, Allen C Ho2, David Sarraf7. 1. Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California. 2. Wills Eye Hospital, Philadelphia, Pennsylvania. 3. Department of Ophthalmology, Universidade Federal of Sao Paulo, Sao Paulo, Brazil. 4. Herzig Eye Institute, Toronto, Canada. 5. Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois. 6. Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, California. 7. Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California. Electronic address: dsarraf@ucla.edu.
Abstract
PURPOSE: To evaluate the spectrum of retinal diseases that can demonstrate paracentral acute middle maculopathy and isolated ischemia of the intermediate and deep capillary plexus. DESIGN: Retrospective, multicenter, observational case series. METHODS: This is a retrospective case series review of 9 patients (10 eyes) from 5 centers with paracentral acute middle maculopathy lesions and previously unreported retinal vascular etiologies. Case presentations and multimodal imaging, including color photographs, near-infrared reflectance, fluorescein angiography, spectral-domain optical coherence tomography (SD OCT), and orbital color Doppler imaging, are described. Baseline and follow-up findings are correlated with clinical presentation, demographics, and systemic associations. RESULTS: Five men and 4 women, aged 27-66 years, were included. Isolated band-like hyperreflective lesions in the middle retinal layers, otherwise known as paracentral acute middle maculopathy, were observed in all patients at baseline presentation. Follow-up SD OCT analysis of these paracentral acute middle maculopathy lesions demonstrated subsequent thinning of the inner nuclear layer. Novel retinal vascular associations leading to retinal vasculopathy and paracentral acute middle maculopathy include eye compression injury causing global ocular ischemia, sickle cell crisis, Purtscher's retinopathy, inflammatory occlusive retinal vasculitis, post-H1N1 vaccine, hypertensive retinopathy, migraine disorder, and post-upper respiratory infection. CONCLUSION: Paracentral acute middle maculopathy lesions may develop in a wide spectrum of retinal vascular diseases. They are best identified with SD OCT analysis and may represent ischemia of the intermediate and deep capillary plexus. These lesions typically result in permanent thinning of the inner nuclear layer and are critical to identify in order to determine the cause of unexplained vision loss.
PURPOSE: To evaluate the spectrum of retinal diseases that can demonstrate paracentral acute middle maculopathy and isolated ischemia of the intermediate and deep capillary plexus. DESIGN: Retrospective, multicenter, observational case series. METHODS: This is a retrospective case series review of 9 patients (10 eyes) from 5 centers with paracentral acute middle maculopathy lesions and previously unreported retinal vascular etiologies. Case presentations and multimodal imaging, including color photographs, near-infrared reflectance, fluorescein angiography, spectral-domain optical coherence tomography (SD OCT), and orbital color Doppler imaging, are described. Baseline and follow-up findings are correlated with clinical presentation, demographics, and systemic associations. RESULTS: Five men and 4 women, aged 27-66 years, were included. Isolated band-like hyperreflective lesions in the middle retinal layers, otherwise known as paracentral acute middle maculopathy, were observed in all patients at baseline presentation. Follow-up SD OCT analysis of these paracentral acute middle maculopathy lesions demonstrated subsequent thinning of the inner nuclear layer. Novel retinal vascular associations leading to retinal vasculopathy and paracentral acute middle maculopathy include eye compression injury causing global ocular ischemia, sickle cell crisis, Purtscher's retinopathy, inflammatory occlusive retinal vasculitis, post-H1N1 vaccine, hypertensive retinopathy, migraine disorder, and post-upper respiratory infection. CONCLUSION:Paracentral acute middle maculopathy lesions may develop in a wide spectrum of retinal vascular diseases. They are best identified with SD OCT analysis and may represent ischemia of the intermediate and deep capillary plexus. These lesions typically result in permanent thinning of the inner nuclear layer and are critical to identify in order to determine the cause of unexplained vision loss.
Authors: Thomas S Hwang; Miao Zhang; Kavita Bhavsar; Xinbo Zhang; J Peter Campbell; Phoebe Lin; Steven T Bailey; Christina J Flaxel; Andreas K Lauer; David J Wilson; David Huang; Yali Jia Journal: JAMA Ophthalmol Date: 2016-12-01 Impact factor: 7.389