Paracentral Acute Middle Maculopathy in Nonischemic Central Retinal Vein Occlusion

• Published in: American journal of ophthalmology Vol. 158; no. 2; pp. 372 - 380.e1
• Main Authors: Rahimy, Ehsan, Sarraf, David, Dollin, Michael L, Pitcher, John D, Ho, Allen C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2014; Elsevier Limited
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Diabetes; Diabetic retinopathy; Diagnosis, Differential; Female; Fluorescein Angiography - methods; Fundus Oculi; Glaucoma; Health Insurance Portability & Accountability Act 1996-US; Humans; Hypertension; Ischemia; Lupus; Macula Lutea - pathology; Male; Marathons; Medical imaging; Middle Aged; Ophthalmology; Patients; Retinal Diseases - diagnosis; Retinal Diseases - etiology; Retinal Vein Occlusion - complications; Retinal Vein Occlusion - diagnosis; Standard deviation; Tomography, Optical Coherence - methods; Tuberculosis; Veins & arteries; Visual Acuity; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2014.04.024

Purpose To better characterize a novel spectral-domain optical coherence tomography (OCT) presentation, termed paracentral acute middle maculopathy, to describe this finding in patients with nonischemic central retinal vein occlusion (CRVO), and to support a proposed pathogenesis of intermediate and deep retinal capillary ischemia. Design Retrospective observational case series. Methods Clinical histories, high-resolution digital color imaging, red-free photography, fluorescein angiography, near-infrared reflectance, and spectral-domain OCT images of 484 patients with acute CRVO from 2 centers were evaluated for the presence of coexisting paracentral acute middle maculopathy. Results Of 484 patients diagnosed with CRVO, 25 (5.2%) demonstrated evidence of concurrent paracentral acute middle maculopathy. Patients averaged 51 years of age and presented with complaints of paracentral scotomas. All patients demonstrated hyper-reflective plaquelike lesions at the level of the inner nuclear layer by spectral-domain OCT and showed corresponding dark-gray lesions on near-infrared reflectance and perivenular deep retinal whitening on color fundus photography. There was no fluorescein angiographic correlate to these lesions. On follow-up spectral-domain OCT imaging, the lesions had resolved into areas of inner nuclear layer atrophy with persistence of scotomas. Conclusions Paracentral acute middle maculopathy refers to characteristic hyper-reflective spectral-domain OCT lesions involving the middle layers of the retina at the level of the inner nuclear layer that may develop in response to ischemia of the intermediate and deep capillary plexuses. This series is the largest to describe this spectral-domain OCT finding to date, and it is the first to associate it with nonischemic CRVO.