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Nitroglycerin as a Treatment Modality for Recurrent Isolated Paracentral Acute Middle Maculopathy: A Case Report
Jason K Sendek1, Anita Goyal2, Robert G Josephberg2
1Ophthalmology, Briarcliff High School, Briarcliff Manor, USA.
Abstract:
Paracentral acute middle maculopathy (PAMM) is a condition characterized by ischemia affecting the deep capillary plexus layer of the macula, often resulting in a paracentral visual scotoma. PAMM has been reported in association with retinal vascular diseases or as an isolated phenomenon in young and healthy individuals. There is currently no treatment for PAMM. We report a case in which sublingual nitroglycerin reversed developing visual scotomas, or blind spots, in a patient with known recurrent episodes of PAMM. This case describes a male patient with previously documented evidence of PAMM in both eyes following episodes of extreme physical activity or dehydration. These episodes would often last days without ultimate resolution. After one such occurrence in his right eye, the patient was treated with a sublingual nitroglycerin tablet immediately after the development of new visual scotomas. The patient's visual symptoms improved within minutes of administering sublingual nitroglycerin, and completely resolved within hours.
Insights
Sublingual nitroglycerin may rapidly resolve visual disturbances caused by paracentral acute middle maculopathy (PAMM). This case study suggests a potential new treatment for PAMM, a condition currently lacking therapeutic options.
Area of Science:
- Ophthalmology
- Vascular Biology
- Retinal Imaging
Background:
- Paracentral acute middle maculopathy (PAMM) involves ischemia of the macula's deep capillary plexus.
- PAMM can cause paracentral visual scotomas and is associated with vascular conditions or occurs in healthy individuals.
- Currently, no established treatments exist for PAMM.
Observation:
- A male patient experienced recurrent episodes of PAMM, often linked to physical exertion or dehydration.
- During a recent episode, the patient developed new visual scotomas in his right eye.
- The patient had a history of PAMM in both eyes.
Findings:
- Sublingual nitroglycerin was administered immediately after the onset of visual scotomas.
- Nitroglycerin treatment led to rapid improvement in visual symptoms within minutes.
- Complete resolution of visual symptoms occurred within hours of sublingual nitroglycerin administration.
Implications:
- Sublingual nitroglycerin shows potential as a rapid-acting intervention for acute PAMM episodes.
- This finding could offer a novel therapeutic approach for patients suffering from recurrent PAMM.
- Further research is warranted to explore the efficacy and mechanisms of nitroglycerin in treating PAMM.
