Paracentral Acute Middle Maculopathy in a Fasting Patient After Cataract Surgery and Its Response to Hyperbaric Oxygen Therapy

• Published in: Photodiagnosis and photodynamic therapy Vol. 43; p. 103714
• Main Author: Gunay, Betul Onal
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-09-2023
• Subjects: Cataract surgery; Fasting; Hyperbaric oxygen theraphy; PAMM; Phacoemulsification; Cataract surgery; Fasting; Hyperbaric oxygen theraphy; Phacoemulsification; PAMM; OCT
• ISSN: 1572-1000; 1873-1597
• DOI: 10.1016/j.pdpdt.2023.103714

•Dehydration due to fasting might play a role in the case of subsequent infarction of the inner retina and the development of PAMM with the help of comorbid cardiovascular compromise after cataract surgery.•Early diagnosis with prompt referral to hyperbaric oxygen treatment may lead to favourable visual results in patients with PAMM.
Paracentral acute middle maculopathy (PAMM) is a structural optic coherence tomography (OCT) sign secondary to ischemia in the intermediate and deep retinal vascular network, characterized by hyperreflectivity in the inner nuclear layer (INL).
Our objective is to demonstrate PAMM development following uncomplicated cataract surgery, possibly triggered by fasting and dehydration. We also aim to emphasize the potential role of hyperbaric oxygen therapy in treating PAMM.
A 66-year-old man with a past medical history of Neurofibromatosis type 1 and cardiovascular disease underwent uncomplicated cataract surgery in the left eye. The patient was also fasting due to Ramadan. The patient complained of very low vision during the routine postoperative examination on the third day. His best-corrected visual acuity (BCVA) was counting fingers at 1 meter. His anterior and posterior segment examination was unremarkable. In infrared imaging, a large hyporeflective area was observed in the parafoveal region, and structural OCT also showed increased hyperreflectivity in the middle retinal layers corresponding to the junction of INL and outer plexiform layer (OPL) involving the entire INL which suggested PAMM. Following 14 sessions of hyperbaric oxygen therapy, the patient's BCVA increased to 0.9 on the 14th day of diagnosing PAMM.
To the best of our knowledge, this is the first case representing a patient with PAMM triggered by fasting and cataract surgery who responded positively to hyperbaric oxygen therapy. However, triggering of PAMM by fasting is entirely unproven and that this observation occured in a highly complex case with many other possible contributing factors. Also, the triggering of PAMM by some manipulation during surgery is equally unproven.