Paracentral acute middle maculopathy as a heralding presentation of ocular ischemic syndrome in the setting of total internal carotid artery occlusion.

PURPOSE: To describe a unique case of paracentral acute middle maculopathy (PAMM) that heralded the presentation of ocular ischemic syndrome (OIS).

METHODS

Medical records of a patient with PAMM and OIS were retrospectively reviewed.

RESULTS

A 72-year-old male presented with foggy vision in the right eye (OD). Macular optical coherence tomography (OCT) revealed PAMM OD. Regression of the hyper-reflective lesions preceded a significant decline in visual acuity from 20/25 to 20/600 OD. The right eye was diagnosed with OIS, showing ischemia and diffuse venular leakage on fluorescein angiography. Carotid Doppler and CT angiography revealed total occlusion of the right ICA. Medical management ensued. No neurovascular or cardiovascular events occurred in the 2-year follow-up. Final visual acuity was hand motions OD.

CONCLUSIONS

We describe a patient with total right ICA occlusion that presented with PAMM followed by OIS. Diagnostic imaging and ischemic/embolic work-up are essential for patients with PAMM and OIS.