Paracentral Acute Middle Maculopathy in Pregnancy

Area of Science:

• Ophthalmology
• Retinal Imaging
• Women's Health

Background:

• Acute monocular vision loss in pregnancy can be challenging to diagnose.
• Conditions like optic neuritis are often considered, but may not fully explain the symptoms.
• Paracentral acute middle maculopathy (PAMM) is a less common cause of vision changes.

Purpose of the Study:

• To report a case of paracentral acute middle maculopathy (PAMM) in a pregnant patient.
• To highlight the diagnostic utility of optical coherence tomography angiography (OCT-A) in such cases.
• To emphasize the importance of considering PAMM in pregnant women with acute visual disturbances.

Main Methods:

• Case presentation of a 31-year-old pregnant woman with acute, painless, unilateral vision loss.
• Neuroimaging and hypercoagulable workup were performed.
• Macular optical coherence tomography (OCT) and OCT angiography (OCT-A) were utilized for detailed retinal assessment.

Main Results:

• Macular OCT revealed a hyperreflective band in the inner nuclear layer, indicative of PAMM.
• OCT-A demonstrated flow attenuation in the outer retinal capillary plexus, supporting the PAMM diagnosis.
• The findings were crucial in differentiating PAMM from optic neuritis.

Conclusions:

• Paracentral acute middle maculopathy (PAMM) should be considered in pregnant patients presenting with acute visual changes.
• OCT-A is a valuable tool, complementing macular OCT, for evaluating vision loss that mimics retrobulbar optic neuropathy.
• Early and accurate diagnosis using advanced imaging techniques is essential for appropriate management.