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  • Retina/Vitreous

    Review of: Paracentral acute middle maculopathy as a specific sign of arteritic anterior ischemic optic neuropathy

    Mairot K, Gascon P, Stolowy N, et al. American Journal of Ophthalmology, in press 2023

    The presence of paracentral acute middle maculopathy (PAMM) on OCT scans appears to be a highly specific test for arteritic anterior ischemic optic neuropathy (arteritic-AION) with a high positive predictive value. However, sensitivity is limited.

    Study design

    This retrospective, cross-sectional study evaluated 45 patients diagnosed with anterior ischemic optic neuropathy; 17 had arteritic-AION and 28 had nonarteritic-AION. Macular spectral domain OCT (SD-OCT) imaging was used to detect the presence of PAMM, and these findings were then compared between the two patient groups.


    Macular SD-OCT revealed PAMM in 4 eyes, all of which were in the arteritic-AION group, revealing 100% specificity of PAMM for detecting arteritic-AION (95% IC, 88.06%–100%) and a 100% positive predictive value. However, the sensitivity of PAMM for detecting arteritic-AION was only 19.1% (95% IC, 5.5–42.0).


    The study is limited by its small sample size and heterogeneity in regard to patient factors, including comorbid ocular and systemic diagnoses (e.g., diabetic retinopathy and carotid stenosis). Larger-scale, adequately powered studies are necessary to better qualify the sensitivity and specificity of macular OCT–identified PAMM in the diagnosis of arteritic-AION.

    Clinical significance

    Arteritic-AION secondary to giant cell arteritis (GCA) requires urgent diagnosis and treatment. In this study, PAMM appears to be a highly specific test for the detection of arteritic-AION, with SD-OCT diagnosing 23.5% of arteritic-AION cases on the basis of PAMM alone with no false positives. Therefore, using macular SD-OCT to evaluate the presence of PAMM should be considered for AION work-up to aid in prompt diagnosis of arteritic-AION and GCA.

    Dr. Ali Khan discloses financial relationships with Allergan, Apellis Pharmaceuticals, Genentech (Consultant/Advisor); Regeneron Pharmaceuticals (Grant Support).