High Frequency of Paracentral Acute Middle Maculopathy among symptomatic post–cardiac surgery patients

PURPOSE: To investigate the incidence, clinical presentation, optical coherence tomography (OCT) features, and visual outcomes of paracentral acute middle maculopathy (PAMM) in patients presenting with visual symptoms after cardiac surgery. METHODS: Retrospective observational study of patients who developed new visual symptoms after cardiac surgery and underwent ophthalmologic consultation at a tertiary referral center within 6 weeks from surgery. Collected data included visual symptoms, best-corrected visual acuity (BCVA), and OCT features. RESULTS: Among 67 patients evaluated, 16 (23.9%) were diagnosed with PAMM. Mean age was 64.6 ± 10.8 years. Paracentral scotomas were reported in 31% of patients, while other frequently reported symptoms included photopsia (53%), floaters (38%), and blurred vision (25%). Cotton wool spots and retinal ischemic perivascular lesions were observed in 43.8% and 25% of patients, respectively. Among patients with available follow-up (n = 10), mean BCVA improved from 20/34 (logMAR 0.23) at presentation to 20/20 (logMAR 0.00) at last follow-up (p = 0.021). CONCLUSIONS: PAMM is a frequent finding in patients with visual symptoms after cardiac surgery, reflecting a substantial burden of retinal microvascular ischemia in this high-risk population. OCT enables identification of retinal microvascular ischemia despite often preserved visual acuity.