Paracentral acute middle maculopathy in patient with atherosclerosis and angioplasty with stents in the coronary artery

Paracentral acute middle maculopathy following coronary angiography

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.