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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Retina
Case 88
Patient presentation: A 37-year-old woman presented to a tertiary retina clinic with decreased vision in the right eye, as well as right eye pain with photophobia and nausea. She denied flashes, floaters or recent trauma. She has a history of alpha thalassemia and pulmonary tuberculosis, which was appropriately treated 3 years prior.
On examination, her best-corrected distance visual acuity was 20/20 OD and 20/70 OS (pin-holed to 20/50). IOP was 14 mmHg OD and 15 mmHg OS. There was no RAPD. Slit lamp examination was unremarkable. Optos fundus photographs were taken and are shown below:
Question 1: Describe the funduscopic findings in the photograph.
Question 2: Based on the presentation and fundus photos, what is the main diagnosis?
OCT images of the macula were taken and shown below:
Question 3: Describe the OCT images of the macula.
Question 4: Based on the OCT macula, what is the secondary diagnosis in addition to CRVO?
Question 5: Which of the following statements is true regarding PAMM?
References:
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Fumi D, Ruggeri F, Fasciolo D, Antonello E, Burtini G, Abdolrahimzadeh S. Paracentral Acute Middle Maculopathy (PAMM) in Ocular Vascular Diseases-What We Know and Future Perspectives. Vision (Basel). 2025;9(1):19. Published 2025 Mar 3. doi:10.3390/vision9010019
Learning Objectives:
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To recognize the funduscopic appearance of non-ischemic CRVO.
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To recognize the OCT findings of PAMM.
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To understand the role of further investigations in patients with PAMM.
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