Topic outline

  • Grand Rounds

    We report a case of paracentral acute middle maculopathy (PAMM) associated antiphospholipid antibody syndrome, and impending central retinal vein occlusion (CRVO). A patient with a medical history of iron deficiency anemia, polycystic ovarian syndrome (PCOS), Class 3 severe obesity, insomnia and anxiety, acutely presented with decreased vision in her left eye that started when she woke up in the morning. Vision in her left eye was 20/150. Fundus examination showed perivenular whitening, and two isolated peripheral hemorrhages. Optical coherence tomography (OCT) showed a multiple hyperreflective lesions confined to the inner nuclear layer (INL) consistent with PAMM. After a week her symptoms improved. Her dilated retinal vein and the INL hyperreflexia on OCT were reduced, and atrophy of the INL layer was present. She had positive serological findings for anti-cardiolipin antibodies and lupus anticoagulant; therefore, she was diagnosed with antiphospholipid antibody syndrome. If the impending CRVO is associated with visual impairment, PAMM should be considered. In the presence of retinal vasculopathy without atherosclerotic factors, APS should be considered.

    Presentation Date: 01/25/2024
    Issue Date: 02/02/2024