High Yield of Systemic Workup in Patients with Acute Isolated Paracentral Acute Middle Maculopathy

Area of Science:

• Ophthalmology
• Neurology
• Cardiology

Background:

• Paracentral acute middle maculopathy (PAMM) is an increasingly recognized condition affecting the macula.
• Systemic evaluation is crucial for understanding potential underlying causes of ocular diseases.

Purpose of the Study:

• To determine the diagnostic yield of a structured systemic workup for patients presenting with acute visual symptoms and diagnosed with isolated paracentral acute middle maculopathy (iPAMM).

Main Methods:

• Retrospective cohort study of 37 patients diagnosed with iPAMM between 2015 and 2025.
• Systemic workup included brain imaging, carotid imaging, echocardiography, and Holter monitoring.
• Analysis of demographics, comorbidities, ocular features, visual outcomes, and correlations between baseline characteristics and systemic findings.

Main Results:

• Abnormal systemic findings were detected in 63.6% of patients who underwent workup.
• Cerebrovascular abnormalities were common (55% on brain imaging), with nearly half previously unrecognized.
• Diagnostic yield increased significantly with age, being highest in patients aged 65 and older (87.5%).

Conclusions:

• A structured systemic workup frequently uncovers significant, often silent, cerebrovascular and cardiovascular pathology in acutely symptomatic iPAMM patients.
• Targeted systemic evaluation is supported in this population, particularly for older individuals.
• Findings are specific to acutely symptomatic iPAMM and should not be generalized to incidentally detected cases.