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Acute retinal ischaemia associated with paracentral acute middle maculopathy detected on multimodal imaging: a premonitory sign of severe carotid occlusive disease
  1. Fares Antaki1,2,
  2. Daniel Milad1,2 and
  3. Thierry Hamel3
  1. 1Department of Ophthalmology, Université de Montréal, Montréal, Québec, Canada
  2. 2Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
  3. 3Clinique d'Ophthalmologie Brome-Missisquoi, Cowansville, Québec, Canada
  1. Correspondence to Dr Fares Antaki; fares.antaki{at}


A man in his 60s presented with a subacute paracentral scotoma and preserved visual acuity in the left eye. He was found to have a very subtle area of deep retinal whitening at the macula and multiple retinal cholesterol emboli. Optical coherence tomography (OCT) with En face imaging revealed globular paracentral acute middle maculopathy (PAMM). A diagnosis of PAMM associated with branch artery occlusion was made and the patient was immediately transferred to the nearest stroke centre. Investigations revealed severe carotid occlusive disease for which the patient underwent carotid endarterectomy. Paracentral scotomas in patients with little clinical findings on fundus examination should raise the suspicion for PAMM, which is easily identifiable on OCT. Eye care professionals must recognise PAMM as a possible sign of acute retinal arterial ischaemia—an ocular and systemic emergency that requires immediate referral to specialised stroke centres.

  • Macula
  • Retina
  • Neuroopthalmology
  • Stroke

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  • Contributors FA and TH diagnosed and followed the patient. FA conceived the paper. FA and TH collected the data. FA interpreted the multimodal retinal imaging. FA and DM drafted the initial manuscript. FA prepared the figures. FA and TH supervised the project. All authors had access to the underlying data, which they verified. All authors edited and revised the manuscript before approving its final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.