Case Report: Transient monocular vision loss with isolated paracentral acute middle maculopathy on optical coherence tomography: beware of giant cell arteritis

We describe a case of transient monocular vision loss (TMVL) and paracentral acute middle maculopathy (PAMM) on optical coherence tomography (OCT) as the only ocular presentation of biopsy-proven GCA. An 80-year-old woman presented 4 days after an episode of TMVL in the right eye, which lasted for 2...

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Bibliographic Details
Published in:Frontiers in neurology Vol. 16; p. 1672043
Main Authors: Alencastro Landim, George, Bénard-Séguin, Etienne, Newman, Nancy J., Biousse, Valérie
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 01.10.2025
Subjects:
giant cell arteritis
optical coherence tomography
paracentral acute middle maculopathy (PAMM)
retinal arterial ischemia
transient monocular vision loss
giant cell arteritis
transient monocular vision loss
optical coherence tomography
paracentral acute middle maculopathy (PAMM)
retinal arterial ischemia
ISSN:1664-2295, 1664-2295
Online Access:Get full text
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Summary:We describe a case of transient monocular vision loss (TMVL) and paracentral acute middle maculopathy (PAMM) on optical coherence tomography (OCT) as the only ocular presentation of biopsy-proven GCA. An 80-year-old woman presented 4 days after an episode of TMVL in the right eye, which lasted for 2 hours and spontaneously resolved. She also had jaw claudication for 1 month. Visual acuity was 20/20 in both eyes, with no relative afferent pupillary defect. Funduscopic examination was normal. Humphrey visual fields (HVF 24-2) were full in both eyes. Spectral domain OCT of the right eye demonstrated a focal lesion with increased hyperreflectivity at the level of the inner nuclear layer, consistent with PAMM. Fluorescein angiography and indocyanine angiography were normal. She was immediately treated with intravenous steroids for presumed giant cell arteritis (GCA), confirmed subsequently by temporal artery biopsy. Most reported GCA patients with PAMM have had permanent vision loss and other obvious funduscopic findings. This unique patient had only TMVL and a normal ophthalmologic examination, including full HVF, and no ischemia on retinal angiographic studies. Immediate macular OCT revealing PAMM in TMVL patients older than age 50 years should suggest GCA and prompt immediate treatment to prevent permanent vision loss.
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ISSN:1664-2295
1664-2295
DOI:10.3389/fneur.2025.1672043