Paracentral Acute Middle Maculopathy Prompting Diagnosis of Severe Aortic Regurgitation and Ascending Aortic Aneurysm.

PURPOSE: To report a case of paracentral acute middle maculopathy (PAMM) in which persistent paracentral dysfunction prompted cardiovascular investigation and diagnosis of severe aortic regurgitation, reduced ejection fraction, and ascending aortic aneurysm.

METHODS

Longitudinal ophthalmic assessment, multimodal retinal imaging, Humphrey SITA Central 10-2 testing, cardiovascular evaluation, surgical findings, histopathology, and targeted aortopathy genetic testing were reviewed.

RESULTS

A 44-year-old man presented with intermittent right-eye visual disturbance and persistent paracentral scotoma after non-explanatory neuroimaging. Unaided visual acuity remained 20/25 (6/7.5; approximately 0.10 logMAR) in each eye, intraocular pressure was 16-19 mmHg, and anterior-segment examination was unremarkable. Multimodal imaging supported PAMM, with structural OCT inner retinal/inner nuclear layer involvement and qualitative OCT-A/fluorescein angiographic parafoveal perfusion compromise. The affected inner retinal/inner nuclear layer region decreased from 45 micrometres to 32 micrometres. Right-eye Humphrey SITA Central 10-2 mean deviation worsened from -3.67 dB on 03 March 2020 to -5.19 dB in February 2026 despite unchanged central acuity. Cardiovascular assessment revealed a 5.5-cm ascending aortic aneurysm, severe aortic regurgitation, and left-ventricular ejection fraction of 49%. The patient underwent elective Bentall procedure, with postoperative ejection-fraction improvement to 55%. No postoperative quantitative OCT-A reperfusion claim is made.

CONCLUSION

PAMM may warrant systemic cardiovascular assessment when ocular findings do not fully explain persistent paracentral dysfunction. This case supports cautious multidisciplinary evaluation while avoiding unsupported claims of causality, quantitative OCT-A perfusion deficit, or postoperative retinal reperfusion.