Optical Coherence Tomography Angiography of Deep Capillary Ischemia

Paracentral acute middle maculopathy (PAMM) is defined by the spectral-domain optical coherence tomography (OCT) finding of paracentral hyper-reflective band-like lesions of the inner nuclear layer (INL) of the macula that progress to corresponding areas of severe INL thinning. En face analysis has enabled more detailed analyses and quantifications of these lesions and has provided insights into the pathogenesis of this abnormality. While there is a wealth of demographic and anatomical data indicating that these PAMM lesions are the result of an INL infarct, OCT angiography is the first modality to provide direct evidence. Several studies have recently shown that old PAMM lesions are indeed associated with ischemia of the deep capillary retinal plexus, while acute lesions may or may not show initial perfusion of the deep capillary retinal plexus.