Claudio Iovino1, Adrian Au2, Prithvi Ramtohul3, Tommaso Bacci4, Abdullah AlBahlal5, Abdullah M Khan5, Abdulelah A Al-Abdullah6, Robert Wendel7, Jay Chhablani8, SriniVas Sadda9, K Bailey Freund10, David Sarraf11. 1. Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy (C.I.). 2. Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA (A. A, D.S.). 3. Ophthalmology Department, Centre Hospitalier Universitaire de l'Hôpital Nord, Chemin des Bourrely, Marseille (P.R.); Ophthalmology Department, APHP, Hôpital Lariboisière, and Université de Paris-Diderot, Paris, France (P.R.). 4. Vitreous Retina Macula Consultants of New York, New York, USA (T.B., K.B.F.). 5. General Ophthalmology, King Khaled Eye Specialist Hospital (A. AlBahlal, A.M.K.). 6. Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia (A.A.A). 7. Retinal Consultants Medical Group, Sacramento, California, USA (R.W.). 8. Department of Ophthalmology, University of Pittsburgh Eye and Ear Institute, Pittsburgh, Pennsylvania (J.C.). 9. Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA (S.S); Department of Ophthalmology, NYU Grossman School of Medicine, New York, USA (K.B.F.). 10. Vitreous Retina Macula Consultants of New York, New York, USA (T.B., K.B.F.); Department of Ophthalmology, NYU Grossman School of Medicine, New York, USA (K.B.F.). 11. Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA (A. A, D.S.); Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California, USA (D.S.). Electronic address: dsarraf@ucla.edu.
Abstract
PURPOSE: To analyze imaging characteristics and the clinical course of patients demonstrating coincident lesions of paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) in the same eye. DESIGN: Retrospective, observational case series. METHODS: Lesions from patients presenting with coincident PAMM and AMN in the same eye were evaluated with multimodal imaging including optical coherence tomography (OCT). The association with ocular and systemic findings was also investigated. RESULTS: Fifteen subjects (17 eyes) were included in the study. The mean age was 44.4 ± 15.3 years and the follow-up period ranged from 1 to 32 weeks (mean, 11.9 ± 11.4 weeks). The mean visual acuity was 0.8 ± 0.6 logarithm of minimal angle of resolution (Snellen equivalent 20/126) at baseline and 0.3 ± 0.4 logarithm of minimal angle of resolution (Snellen equivalent 20/40) at the last follow-up. PAMM and AMN lesions occurred in the setting of Purtscher's retinopathy (4 eyes, 3 patients), retinal vein occlusion (7 eyes, 7 patients), central retinal artery occlusion (1 eye, 1 patient), and idiopathic retinal vasculitis (1 eye, 1 patient). In 4 eyes (3 patients), an association with other ocular disorders was not identified as evaluated with multimodal imaging. Of the total cohort, 11 eyes (64.7%) showed extension of the AMN hyperreflective bands in Henle's fiber layer with a Z-shaped morphology on OCT B-scan. CONCLUSIONS: The presence of coincident PAMM and AMN suggests a common pathophysiologic etiology. This may be the result of retinal vein impairment and hypoperfusion at the level of the deep retinal capillary plexus possibly leading to injury to the Müller glia or photoreceptors in Henle's fiber layer.
PURPOSE: To analyze imaging characteristics and the clinical course of patients demonstrating coincident lesions of paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) in the same eye. DESIGN: Retrospective, observational case series. METHODS: Lesions from patients presenting with coincident PAMM and AMN in the same eye were evaluated with multimodal imaging including optical coherence tomography (OCT). The association with ocular and systemic findings was also investigated. RESULTS: Fifteen subjects (17 eyes) were included in the study. The mean age was 44.4 ± 15.3 years and the follow-up period ranged from 1 to 32 weeks (mean, 11.9 ± 11.4 weeks). The mean visual acuity was 0.8 ± 0.6 logarithm of minimal angle of resolution (Snellen equivalent 20/126) at baseline and 0.3 ± 0.4 logarithm of minimal angle of resolution (Snellen equivalent 20/40) at the last follow-up. PAMM and AMN lesions occurred in the setting of Purtscher's retinopathy (4 eyes, 3 patients), retinal vein occlusion (7 eyes, 7 patients), central retinal artery occlusion (1 eye, 1 patient), and idiopathic retinal vasculitis (1 eye, 1 patient). In 4 eyes (3 patients), an association with other ocular disorders was not identified as evaluated with multimodal imaging. Of the total cohort, 11 eyes (64.7%) showed extension of the AMN hyperreflective bands in Henle's fiber layer with a Z-shaped morphology on OCT B-scan. CONCLUSIONS: The presence of coincident PAMM and AMN suggests a common pathophysiologic etiology. This may be the result of retinal vein impairment and hypoperfusion at the level of the deep retinal capillary plexus possibly leading to injury to the Müller glia or photoreceptors in Henle's fiber layer.