Exploring Patient Demographics and Presence of Retinal Vascular Disease in Paracentral Acute Middle Maculopathy

Purpose: To investigate the sociodemographic profile, the association with retinal vascular diseases (RVD) and systemic comorbidities, and visual outcomes of patients with paracentral acute middle maculopathy (PAMM) in a large, ethnically diverse single-center cohort. Design: Retrospective cohort study. Methods: Electronic health record query for all patients presenting with PAMM at Moorfields Eye Hospital, London, was completed. Detailed demographics, clinical and systemic information were collected and analyzed. Results: A total of 78 eyes of 78 patients with confirmed PAMM were included in the study. 40 patients(51.3%) presented with no RVD, 20 patients(25.6%) with retinal vein occlusion(RVO), 16 patients(20.5%) with retinal artery occlusion(RAO), and two patients(2.6%) with concomitant RAO and RVO. Patients with PAMM+RAO were older than those with RVO(p=0.02) and more likely to have a history of major adverse cardiovascular events(MACE)(p=0.01), with a significantly worse presenting best corrected visual acuity (BCVA)(20/50) compared to patients with RVO (p=0.02) and no RVD (p<0.001). Individuals with isolated PAMM had a significantly higher prevalence of previous MACE (p=0.04) and sickle cell disease (SCD) (p=0.04) compared to those with RVO. At the last follow-up, 64 patients (85.3%) had a good BCVA (>20/32). Conclusions: The significant association of PAMM with RVD supports the hypothesis of an ischemic etiology. Individuals with isolated PAMM had a higher prevalence of MACE and SCD. Thus, it is important to prompt immediate referral for a comprehensive systemic evaluation. Across the whole cohort, PAMM was associated with good BCVA improvement during follow-up, indicating a good visual prognosis.