Paracentral acute middle maculopathy following coronary angiography

Abstract

Purpose: To describe a case of paracentral acute middle maculopathy (PAMM) after coronary angiography.

Observations: A 65-year-old female patient exhibited a dense central scotoma 5 hrs after coronary angiography. She presented the next day to the retina clinic and received a complete visual examination including slit lamp biomicroscopy, dilated fundus examination, fluorescein angiogram (FA), spectral domain optical coherence tomography (SD-OCT) and OCT-Angiography (OCT-A). She was found to have the characteristic findings of PAMM including a hyperreflective band at the inner nuclear layer (INL) with extension into the inner plexiform layer (IPL) and outer plexiform layer (OPL) on imaging.

Conclusions and importance: PAMM lesions can occur immediately following coronary angiography. The acute nature of the presentation and time to examination in this case lend further insights into the pathophysiology of PAMM. When patients undergo cardiovascular interventions and report new onset visual scotomas, the diagnosis of PAMM should be considered with referral for careful ophthalmic examination and work-up.

Keywords: Coronary angiography; PAMM; Paracentral acute middle maculopathy.

Fig. 1

(A) Near-infrared reflectance (NIR) with corresponding spectral domain optical coherence tomography (SD-OCT) of the left eye on initial presentation. Note the hyperreflective band at the inner nuclear layer (INL) with extension into the inner plexiform layer (IPL) and outer plexiform layer (OPL). A mild ERM is present. (B) Near-infrared reflectance (NIR) with corresponding spectral domain optical coherence tomography (SD-OCT) of the left eye at two-week follow up.

Fig. 2

Color fundus photography of the left eye upon initial visit illustrates apparent white discoloration located nasally to the fovea. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Fluorescein angiography (FA) of the left eye shows a blockage of a twig retinal artery with late vascular staining: (A) 0.28 min (B) 4.38 min.

Fig. 4

OCT Angiography of the left eye retinal vessels shows significant capillary dropout in the deep retinal capillary plexus (DCP).

Fig. 5

Near-infrared reflectance (NIR) with corresponding spectral domain optical coherence tomography (SD-OCT) of the left eye at three months follow up. Note reduced hyperreflectivity at the inner nuclear layer (INL) with continued INL thinning.