June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Paracentral acute middle maculopathy(PAMM): clinical characteristics, risk factors, and prognostic outcomes
Author Affiliations & Notes
  • Celeste Limoli
    Ophthalmology, Universita degli Studi di Milano, Milano, Lombardia, Italy
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Laxmi Raja
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Siegfried Wagner
    Institute of Ophthalmology, University College London, London, London, United Kingdom
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Hagar Khalid
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
    Tanta University, Tanta, Gharbia, Egypt
  • Stela Vujosevic
    Eye Clinic, IRCCS MultiMedica, Lombardia, Italy
    Biomedical, Surgical and Dental Sciences, Universita degli Studi di Milano, Milano, Lombardia, Italy
  • Paolo Nucci
    Biomedical, Surgical and Dental Sciences, Universita degli Studi di Milano, Milano, Lombardia, Italy
  • Pearse Keane
    Institute of Ophthalmology, University College London, London, London, United Kingdom
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Josef Christian Huemer
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Footnotes
    Commercial Relationships   Celeste Limoli None; Laxmi Raja None; Siegfried Wagner None; Hagar Khalid None; Stela Vujosevic Abbvie, Apellis, Alimera, Bayer, Novartis, Roche, Boehringher & Ingelheim, Zeiss, Code C (Consultant/Contractor); Paolo Nucci Hoya, Alcon, Essilor-Luxottica, Theá, Code C (Consultant/Contractor); Pearse Keane Apellis, Code C (Consultant/Contractor), Allergan, Topcon, Heidelberg Engineering, Novartis, Roche, Bayer, Code F (Financial Support), Big Picture Medical, Code I (Personal Financial Interest); Josef Huemer None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3664. doi:
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      Celeste Limoli, Laxmi Raja, Siegfried Wagner, Hagar Khalid, Stela Vujosevic, Paolo Nucci, Pearse Keane, Josef Christian Huemer; Paracentral acute middle maculopathy(PAMM): clinical characteristics, risk factors, and prognostic outcomes. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3664.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : PAMM is an optical coherence tomography(OCT) finding characterized by a hyperreflective band at the level of the inner nuclear layer(INL)1. PAMM is a manifestation of INL infarction due to impaired perfusion of the deep vascular complex2,3 and is commonly associated with retinal vascular diseases(RVD) and/or systemic disorders4. The aim of this study was to report the risk factors, clinical characteristics and visual prognosis of patients presenting with PAMM to a regional tertiary ophthalmic hospital.

Methods : In this retrospective study, patients labeled with a diagnosis of PAMM at Moorfields Eye Hospital in London between July 2012 and June 2021 were included. Diagnosis of PAMM was confirmed using clinical details and multimodal imaging by 2 consultant ophthalmologists with fellowship level expertise in medical retina. 3 sub-categories of PAMM were defined according to the association with retinal artery occlusion(RAO), retinal vein occlusion(RVO), or without any RVD association. Fisher’s exact and t tests were used as appropriate. P values<0.05 were considered statistically significant.

Results : 75 eyes of 75 patients with confirmed diagnosis of PAMM were evaluated. There were 19 patients(25.4%) with RVO, 16 patients(21.4%) with RAO, 38 patients(50.6%) with no RVD, and 2 patients(2.6%) with concomitant RAO and RVO(Table 1).
Median age of the cohort was 53 years old (range,19-95 years), and 41.3% were female. Baseline and final mean BCVA was 0.33 logMAR(2.2–0 logMAR) and 0.25 logMAR(2.2–0 logMAR) respectively, showing a significant improvement(p=0.003). In PAMM patients with RAO, baseline BCVA was significantly worse than in patients with RVO(p=0.04) and with no RVD(p=0.001), and age was higher than in RVO sub-group(p=0.03). Prevalence of stroke/myocardial infarction(p=0.04) and sickle cell(SC) disease(p=0.04) differed significantly between patients with RVO and no RVD(Table 2).

Conclusions : Based on our results, PAMM patients with no evidence of RVD showed similar sociodemographic characteristics versus patients with concurrent RVO, but a higher prevalence of cardio-cerebrovascular and SC diseases. It may indicate the association of PAMM with systemic vasculopathies and additional risk factors. In the whole cohort, PAMM was associated with good BCVA improvement during follow-up, suggesting a potential prognostic value. Further studies are needed to elucidate these findings.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

 

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