OCT angiography features of paracentral acute middle maculopathy

Paracentral acute middle maculopathy (PAMM) refers to retinal lesions with changes in the inner nuclear layer on spectral domain optical coherence tomography (OCT). PAMM is associated with retinal vascular pathology involving the deep capillary plexus. We report two cases of PAMM in Indian subjects using multimodal imaging highlighting the OCT angiography (OCTA) findings. The first case is of a middle-aged female with a paracentral scotoma with SS-OCT (swept-source optical coherence tomography) and OCTA findings suggestive of “chronic” PAMM. The second case presented with sudden decreased vision, and multiple creamy white lesions suggestive of “acute” PAMM, imaging features depicting a possible venular obstruction. These cases demonstrate the importance of considering PAMM as a differential diagnosis in patient presenting with nonspecific visual complains and apparently normal ophthalmic examination. The recognition of PAMM should prompt an appropriate evaluation and investigation.