Paracentral Acute Middle Maculopathy Associated With Bilateral Optic Disc Swelling And Meningitis

Abstract

Background/Purpose

To present a novel case of paracentral acute middle maculopathy (PAMM) associated with bilateral optic disc swelling

Methods

Retrospective case report

Results

A 67-year-old female presented with sudden onset of central vision loss, and subsequent bilateral optic disc edema, retinal vessel attenuation and anterior uveitis. Cerebrospinal fluid analysis showed signs of inflammation. Spectral-domain optical coherence tomography (SD-OCT) demonstrated the pathognomonic hyperreflectivity of the middle retinal layers consistent with PAMM. Swept-source OCT angiography with custom vessel analysis demonstrated a 18.3% decrease in the deep retinal vascular density and 2.4 times increase in absent flow area in the affected eye compared to the fellow eye.

Conclusion

This case demonstrates a novel association between PAMM and bilateral optic disc swelling secondary to central nervous system inflammation and possible infection. While SD-OCT is valuable in detecting PAMM, OCT angiography with vessel analysis can provide additional insight on the disease mechanism.