RCOphth Annual Congress 2026

INTRODUCTION

•Paracentral acute middle maculopathy (PAMM) is caused by ischaemia of the intermediate and deep retinal capillary plexuses.

•It presents as hyperreflective band-like lesions within the inner nuclear layer on OCT.

•PAMM is commonly associated with retinal vascular occlusion, systemic hypoperfusion, and hypercoagulable states.

•Cases in otherwise healthy young patients are rare.

•Iron deficiency anaemia and associated haematinic deficiencies may contribute to endothelial dysfunction.

CASE SUMMARY

•17-year-old female presented with sudden central visual loss in the right eye.

•Symptoms:

•Dense central scotoma

•Blurred vision

•Fatigue and dizziness

•Heavy menstrual bleeding

•Received high-dose tranexamic acid for menorrhagia.

•No prior ocular or thrombotic history.

Examination

•Visual acuity: Counting fingers OD

•Subtle grey-white parafoveal retinal whitening

•Left eye normal

INVESTIGATIONS

OCT Findings

•Hyperreflective band involving:

•Inner nuclear layer

•Inner plexiform layer

•Consistent with PAMM

OCTA Findings

•Mild deep capillary plexus flow reduction

FFA Findings

•No retinal non-perfusion

•No vasculitis

•No transit delay

Parameter	Result
Haemoglobin	76 g/L
Ferritin	4 µg/L
Vitamin B12	18 pmol/L
Folate	2.2 µg/L
Homocysteine	Mildly elevated

Blood Tests

Additional Workup

•Thrombophilia screen: Negative

•MRI brain: Normal

•Echocardiogram: Normal

DISCUSSION

•PAMM represents ischaemia of the deep retinal capillary plexus.

•Severe iron deficiency may cause:

•Tissue hypoxia

•Endothelial dysfunction

•Reactive thrombocytosis

•Concurrent B12 and folate deficiency may elevate homocysteine and increase thrombotic risk.

•Tranexamic acid may theoretically contribute via antifibrinolytic effects.

•Despite haematological correction, visual recovery remained limited due to irreversible inner retinal ischaemic damage.

CONCLUSION

•PAMM should be considered in young patients presenting with unexplained central visual loss.

•Multi-haematinic deficiency can contribute to retinal microvascular ischaemia even without conventional vascular risk factors.

•Early systemic investigation and correction of deficiencies are essential.

•Established PAMM may result in permanent visual impairment.

RCOphth Annual Congress 2026

Paracentral Acute Middle Maculopathy Secondary to Multi-haematinic Deficiency Anaemia in an adolescent

Poster Presenter

Authors

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