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Optical Coherence Tomography Angiography of Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy

Paula E. Pecen, MD1; Adiel G. Smith, MD1; Justis P. Ehlers, MD1
[+] Author Affiliations
1Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
JAMA Ophthalmol. 2015;133(12):1478-1480. doi:10.1001/jamaophthalmol.2015.4100.
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This case report describes acute macular neuroretinopathy/paracentral acute middle maculopathy in a pregnant woman.

Acute macular neuroretinopathy (AMN) has been characterized as wedge-shaped superficial retinal defects in the macula, resulting in paracentral scotomas. It has been associated with vasoconstrictors and sympathomimetics.1 In 2013, paracentral acute middle maculopathy (PAMM) was described as an AMN variant, seen as a hyperreflective band involving the middle retinal layers on spectral-domain optical coherence tomography (SD-OCT).1 Type 1 PAMM lesions involve layers above the outer plexiform layer (OPL), reflecting superficial or intermediate capillary plexus occlusion; type 2 lesions involve layers below the OPL, affecting the deep capillary plexus.1

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Figure 1.
Near-Infrared Reflectance (NIR) Imaging and Spectral-Domain Optical Coherence Tomography (SD-OCT) of a Paracentral Acute Middle Maculopathy Lesion in the Right Eye

A-C, At initial presentation, NIR imaging shows a dark lesion (arrowhead in B) in the superotemporal macula (A and B) and SD-OCT shows corresponding focal hyperreflectivity (arrowhead) (N indicates nasal; S, superior; and T, temporal) (C). D-F, One month later, NIR imaging shows resolution of the lesion (arrowhead in E) (D and E) and SD-OCT shows corresponding inner nuclear layer thinning (arrowhead) (F). The horizontal lines in A and D indicate the location of the SD-OCT scans in C and F, respectively.

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Figure 2.
Optical Coherence Tomography Angiography (OCTA) and Spectral-Domain Optical Coherence Tomography (SD-OCT) 2 Months After Initial Presentation

A and B, Two months after initial presentation, OCTA reveals outer retinal capillary nonperfusion (arrowhead) at the location of the lesion in the affected eye (A) and intact outer retinal capillary perfusion in the unaffected eye (B). C and D, Corresponding SD-OCT reveals OCTA segmentation (between red and green lines).

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