Paracentral Acute Middle Maculopathy (PAMM) The Inner and middle Retinal Ischemic Cascade Spectrum (IMRICS) disorders: A systematic review.

Seyed Hossein Abtahi1 *, Ramin Nourinia1 , Hamid Ahmadieh1 , Mehdi Mazloumi2

  1. Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences; Tehran; Iran
  2. Vitreous Retina Macula Consultants of New York, New York, United States.

Abstract: Paracentral Acute Middle Maculopathy (PAMM) is an Optical Coherence topography (OCT) finding characterized by a hyper-reflective band-like lesion due to ischemia of the inner nuclear layer (INL). In this study, the first time, the aim was to provide a systematic literature review regarding the gamut of causes of PAMM and imaging studies on its pathophysiology.

Methods: For the time period 2013-2020, a PubMed search was made for the studies concerning keyword “Paracentral Acute Middle Maculopathy”. Overall, 127 were examined for relevance. Six papers were excluded due to not being original research. Forty one studies reported PAMM lesions in the context of varied conditions. Sixty eight studies reported imaging, pathophysiology and microanatomic features of PAMM. Content of the papers were meticulously analyzed and discussed.

Results: PAMM occurs in the context of the following two categories: Ocular origin: 1. Venular Impedance: retinal vein occlusion (RVO) especially Central RVO 2. Arterial insufficiency: Partial occlusion of central retinal artery (CRA): Incomplete CRA occlusion (CRAO), Reperfused CRAO, Branch retinal artery occlusion (BRAO), Incomplete cilioretinal artey occlusion (CILRAO), ocular ischemia syndrome 3. Combined vascular insufficiency: 4. Ocular Surgery sequels: 5. Ocular Inflammation: birdshot chorioretinopathy 6. Ocular comorbidities: primary congenital glaucoma 7. Ocular trauma: orbital compression injury Systemic origin: 1. Arterial flow failure 2. Surgery 3. Infections 4. Hypercoagulable states 5. Autoimmune disorders 6. medication side-effects 7. neurological conditions 8. body trauma 9. Malignancy

Conclusion: PAMM is a mere spectral domain OCT finding; it per se does not suggest any specific pathological basis. Indeed, “INL infarction” may provide a more accurate description of this entity. Retina specialists may be tempted to see evidence that resolved PAMM, perivenular PAMM, globular PAMM, BRAO, CRAO, CILARO, BRVO and CRVO represent a united disease process accompanied by INL infarction, as a common point. This process can be called as ‘Inner and middle retinal ischemic cascade spectrum’ (IMRICS).





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