Paracentral Acute Middle Maculopathy Prompting Diagnosis of Severe Aortic Regurgitation and Ascending Aortic Aneurysm

Purpose: To report a case of paracentral acute middle maculopathy (PAMM) in which persistent paracentral dysfunction prompted cardiovascular investigation and diagnosis of severe aortic regurgitation, reduced ejection fraction, and ascending aortic aneurysm. Methods: Longitudinal ophthalmic assessment, multimodal retinal imaging, Humphrey SITA Central 10-2 testing, cardiovascular evaluation, surgical findings, histopathology, and targeted aortopathy genetic testing were reviewed. Results: A 44-year-old man presented with intermittent right-eye visual disturbance and persistent paracentral scotoma after non-explanatory neuroimaging. Unaided visual acuity remained 20/25 (6/7.5; approximately 0.10 logMAR) in each eye, intraocular pressure was 16-19 mmHg, and anterior-segment examination was unremarkable. Multimodal imaging supported PAMM, with structural OCT inner retinal/inner nuclear layer involvement and qualitative OCT-A/fluorescein angiographic parafoveal perfusion compromise. The affected inner retinal/inner nuclear layer region decreased from 45 micrometres to 32 micrometres. Right-eye Humphrey SITA Central 10-2 mean deviation worsened from -3.67 dB on 03 March 2020 to -5.19 dB in February 2026 despite unchanged central acuity. Cardiovascular assessment revealed a 5.5-cm ascending aortic aneurysm, severe aortic regurgitation, and left-ventricular ejection fraction of 49%. The patient underwent elective Bentall procedure, with postoperative ejection-fraction improvement to 55%. No postoperative quantitative OCT-A reperfusion claim is made. Conclusion: PAMM may warrant systemic cardiovascular assessment when ocular findings do not fully explain persistent paracentral dysfunction. This case supports cautious multidisciplinary evaluation while avoiding unsupported claims of causality, quantitative OCT-A perfusion deficit, or postoperative retinal reperfusion.