Case 68

Contributor: Arshia Eshtiaghi (CC3)

Patient Presentation: A 45-year-old man presented with a 3-day history of painless blurred vision of his right eye. He had subjectively lost vision in his right eye 3 days prior to presentation, but regained most of his vision a few hours later. He denied any headache, flashes, floaters or field deficit during this acute, transient loss of vision episode. His past medical history includes hypertension that is not currently being treated.

He now reports that he sees "broken glass" through his right eye. On examination, his best-corrected visual acuity is 20/25 OD and 20/20 OS. IOP was within normal limits; there is no RAPD. Fundus examination is shown below:


Question 1: Describe what is seen on fundus examination.

To further investigate, OCT imaging of the right eye was performed and is shown below:


Question 2: Which of the following OCT abnormalities is most characteristic of this patient's condition?

Question 3: What is the value of performing OCT angiography as part of the workup?

Question 4: What is the treatment for PAMM?


  1. Sarraf D, Rahimy E, Fawzi AA, Sohn E, Barbazetto I, Zacks DN, et al. Paracentral acute middle maculopathy a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA Ophthalmol. 2013;

  2. Chen X, Rahimy E, Sergott RC, Nunes RP, Souza EC, Choudhry N, et al. Spectrum of retinal vascular diseases associated with paracentral acute middle maculopathy. Am J Ophthalmol. 2015;

  3. Sridhar J, Shahlaee A, Rahimy E, Hong BK, Khan MA, Maguire JI, et al. Optical Coherence Tomography Angiography and en Face Optical Coherence Tomography Features of Paracentral Acute Middle Maculopathy. Am J Ophthalmol. 2015;


Learning Objectives:

  1. To describe the characteristic OCT findings of paracentral acute middle maculopathy.

  2. To list the main risk factors associated with the development of paracentral acute middle maculopathy.