PARACENTRAL ACUTE MIDDLE MACULOPATHY IN GIANT CELL ARTERITIS

Area of Science:

• Ophthalmology
• Rheumatology
• Vascular Medicine

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis that can lead to severe visual impairment.
• Ophthalmic manifestations of GCA require prompt diagnosis and management.
• Paracentral acute middle maculopathy (PAMM) is an ischemic condition affecting the macula.

Purpose of the Study:

• To document the occurrence of PAMM in patients with GCA.
• To characterize the features and outcomes of PAMM in GCA.
• To identify risk factors for PAMM in GCA patients.

Main Methods:

• Retrospective review of medical records of GCA patients at Rothschild Foundation Hospital.
• Classification of patients into three groups: GCA with PAMM, GCA with ophthalmic involvement without PAMM, and GCA without ophthalmic involvement.
• Analysis of demographic, clinical, laboratory, and imaging data.

Main Results:

• 16 patients (Group 1) had GCA with PAMM among 96 eligible patients.
• Patients with GCA and PAMM were older (mean age 81.6 years).
• Visual prognosis was similar for GCA with PAMM and GCA with other ophthalmic involvement; 35% of PAMM eyes had associated anterior ischemic optic neuropathy.

Conclusions:

• PAMM is a frequent finding in ocular GCA and can be the only presenting sign.
• Optical coherence tomography (OCT) of the macula is crucial for detecting retinal ischemia in suspected GCA with visual changes.
• Isolated PAMM should prompt consideration of GCA in at-risk individuals.