title: Spectrum of Retinal Vascular Diseases Associated With Paracentral Acute Middle Maculopathy.
abstract: OBJECTIVE
  To evaluate the spectrum of retinal diseases that can demonstrate paracentral acute middle maculopathy and isolated ischemia of the intermediate and deep capillary plexus.
  
  
  METHODS
  Retrospective, multicenter, observational case series.
  
  
  METHODS
  This is a retrospective case series review of 9 patients (10 eyes) from 5 centers with paracentral acute middle maculopathy lesions and previously unreported retinal vascular etiologies. Case presentations and multimodal imaging, including color photographs, near-infrared reflectance, fluorescein angiography, spectral-domain optical coherence tomography (SD OCT), and orbital color Doppler imaging, are described. Baseline and follow-up findings are correlated with clinical presentation, demographics, and systemic associations.
  
  
  RESULTS
  Five men and 4 women, aged 27-66 years, were included. Isolated band-like hyperreflective lesions in the middle retinal layers, otherwise known as paracentral acute middle maculopathy, were observed in all patients at baseline presentation. Follow-up SD OCT analysis of these paracentral acute middle maculopathy lesions demonstrated subsequent thinning of the inner nuclear layer. Novel retinal vascular associations leading to retinal vasculopathy and paracentral acute middle maculopathy include eye compression injury causing global ocular ischemia, sickle cell crisis, Purtscher's retinopathy, inflammatory occlusive retinal vasculitis, post-H1N1 vaccine, hypertensive retinopathy, migraine disorder, and post-upper respiratory infection.
  
  
  CONCLUSIONS
  Paracentral acute middle maculopathy lesions may develop in a wide spectrum of retinal vascular diseases. They are best identified with SD OCT analysis and may represent ischemia of the intermediate and deep capillary plexus. These lesions typically result in permanent thinning of the inner nuclear layer and are critical to identify in order to determine the cause of unexplained vision loss.
authors: Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California.
authors: Xuejing
authors: X
authors: Chen
authors: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors: Ehsan
authors: E
authors: Rahimy
authors: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors: Robert C
authors: RC
authors: Sergott
authors: Department of Ophthalmology, Universidade Federal of Sao Paulo, Sao Paulo, Brazil.
authors: Renata P
authors: RP
authors: Nunes
authors: Department of Ophthalmology, Universidade Federal of Sao Paulo, Sao Paulo, Brazil.
authors: Eduardo C
authors: EC
authors: Souza
authors: Herzig Eye Institute, Toronto, Canada.
authors: Netan
authors: N
authors: Choudhry
authors: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors: Nathan E
authors: NE
authors: Cutler
authors: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors: Samuel K S
authors: SK
authors: Houston
authors: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
authors: Marion R
authors: MR
authors: Munk
authors: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
authors: Amani A
authors: AA
authors: Fawzi
authors: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors: Sonia
authors: S
authors: Mehta
authors: Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, California.
authors: Jean-Pierre
authors: JP
authors: Hubschman
authors: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors: Allen C
authors: AC
authors: Ho
authors: Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California. Electronic address: dsarraf@ucla.edu.
authors: David
authors: D
authors: Sarraf
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002196:Capillaries; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology; D055351:Retinal Neurons / Q000473:pathology*; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D018615:Ultrasonography, Doppler, Color; D014792:Visual Acuity / Q000502:physiology