Paracentral Acute Middle Maculopathy Associated with Arteritic Anterior Ischemic Optic Neuropathy in a Case of Giant Cell Arteritis

Background

Giant cell arteritis (GCA) is a systemic granulomatous vasculitis, characterized by granulomatous inflammation of medium- and large-sized vessels that primarily affects the elderly and may result in ischemic injury to the optic nerve and retina. Arteritic anterior ischemic optic neuropathy (A-AION) with secondary permanent visual loss is the most common ocular complication of cranial GCA [1]. Recently, ischemic retinal lesions referred to as Paracentral Acute Middle Maculopathy (PAMM) have been described in GCA, either as an isolated finding or in association with A-AION [2]. First described by Sarraf et al. in 2013, PAMM is an OCT finding characterized by a hyperreflective band in the inner nuclear layer representing ischemia due to compromised perfusion of the intermediate and deep retinal capillary plexus [1], [3]. We report a case of an 81-year-old female with confirmed GCA exhibiting A-AION in association with PAMM and review the literature on PAMM as a specific OCT finding in A-AION and GCA.

Publication History

Received: 25 October 2025

Accepted: 02 December 2025

Article published online:
27 January 2026

• References

• 1 Mairot K, Gascon P, Stolowy N. et al. Paracentral Acute Middle Maculopathy as a Specific Sign of Arteritic Anterior Ischemic Optic Neuropathy. Am J Ophthalmol 2023; 248: 1-7
• 2 Deutsche Ophthalmologische Gesellschaft (DOG), Berufsverband der Augenärzte Deutschlands e. V. (BVA). [Anterior ischemic optic neuropathy (AION): S1 guidelines of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Version: 30.08.2024]. Ophthalmologie 2025; 122 (Suppl. 1) 13-19
• 3 Sarraf D, Rahimy E, Fawzi AA. et al. Paracentral acute middle maculopathy a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA Ophthalmol 2013; 131: 1275-1287
• 4 Klefter ON, Hansen MS, Lykkebirk L. et al. Combining Paracentral Acute Middle Maculopathy and Peripapillary Fluid as Biomarkers in Anterior Ischemic Optic Neuropathy. Am J Ophthalmol 2025; 271: 329-336
• 5 Mairot K, Sené T, Lecler A. et al. Paracentral Acute Middle Maculopathy in Giant Cell Arteritis. Retina 2022; 42: 476-484
• 6 Fumi D, Ruggeri F, Fasciolo D. et al. Paracentral Acute Middle Maculopathy (PAMM) in Ocular Vascular Diseases–What We Know and Future Perspectives. Vision (Basel) 2025; 9: 19
• 7 Kasimov M, Popovic MM, Micieli JA. Paracentral Acute Middle Maculopathy Associated with Anterior Ischemic Optic Neuropathy and Cilioretinal Artery Occlusion in Giant Cell Arteritis. J Neuroophthalmol 2022; 42: e437-e439
• 8 Ahuja AS, El-Dairi MA, Hadziahmetovic M. et al. Paracentral Acute Middle Maculopathy as a Manifestation of Giant Cell Arteritis. J Neuroophthalmol 2021; 41: e153-e156
• 9 Broyles H, Chacko J, Chancellor J. et al. Paracentral Acute Middle Maculopathy as the Initial Presentation of Giant Cell Arteritis. J Neuroophthalmol 2021; 41: e157-e159
• 10 Pellegrini F, Mairot K, Cuna A. et al. Paracentral Acute Middle Maculopathy in Giant Cell Arteriitis. Retin Cases Brief Rep 2024; 18: 285-289