title: Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery.
abstract: OBJECTIVE
  Paracentral acute middle maculopathy (PAMM) diagnosed by spectral domain optical coherence tomography (SD-OCT) in patients with poor visual outcome post cataract surgery.
  
  
  BACKGROUND
  Case series of severe vision loss due to PAMM after cataract surgery.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Cases from five surgical centres in Victoria, Australia.
  
  
  METHODS
  Retrospective analysis of cases with unexplained 'patch-off' vision loss post cataract surgery. All patients in our cohort had PAMM and presumed diagnosis of central or transient retinal artery occlusion.
  
  
  METHODS
  A review of the patient histories focusing on pre-operative ocular and systemic vascular risk factors, anaesthetic and operative factors.
  
  
  RESULTS
  Ten cases were included. All patients had 6/72 Snellen visual acuity or worse noted on day one post surgery. Three patients had features of central retinal artery occlusion consisting of retinal pallor with a 'cherry red' macula but absent relative afferent pupillary defect. Seven had no features of retinal pallor or attenuation of retinal arterioles. On SD-OCT, all eyes had evident PAMM. Six patients had a history of cardiovascular disease or blood dyscrasia.
  
  
  CONCLUSIONS
  PAMM should be considered in patients with 'patch off' visual loss and absence of other fundal signs. We hypothesise that spasm or transient occlusion of central retinal artery leads to arterial hypoperfusion with subsequent ischaemia or infarction of the retina. Underlying arterial disease may have led to pre-existing hypoperfusion that may have been further compromised by raised intraocular pressure during the procedure itself or via raised orbital pressure from the anaesthesia.
authors.affiliation: Medical Retina Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Creese
authors.affiliation: Medical Retina Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Daini
authors.identifier: http://orcid.org/0000-0001-7153-6118
authors.initials: D
authors.lastname: Ong
authors.affiliation: Medical Retina Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sukhpal S
authors.initials: SS
authors.lastname: Sandhu
authors.affiliation: Department of Anaesthesia, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ware
authors.affiliation: Medical Retina Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Alex Harper
authors.affiliation: Medical Retina Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Salmaan H
authors.initials: SH
authors.lastname: Al-Qureshi
authors.affiliation: Medical Retina Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sanjeewa S
authors.initials: SS
authors.lastname: Wickremasinghe
mesh_terms: D000208:Acute Disease; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D015354:Vision, Low / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity
keywords: cataract surgery; paracentral acute middle maculopathy; retinal artery occlusion