Paracentral Acute Middle Maculopathy in a Young Woman: A Case Report

Paracentral acute middle maculopathy is an optical coherence tomography finding that reflects ischemia of the middle retinal layers and typically presents with a paracentral scotoma. We report a 38-year-old woman with hypertension and asthma who presented with a two-year history of a small cloud-like paracentral field defect in the right eye, with minimal recent improvement and no pain, redness, trauma, or previous similar episodes. Visual acuity was 0.8 in both eyes, with normal pupillary responses, color vision, and intraocular pressure. Fundus examination showed subtle perifoveal discoloration in the right macula, mild vessel tortuosity, and early hypertensive changes in both eyes, while the left macula was normal. Multimodal imaging with optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography were performed. The right eye showed reduced flow in the deep capillary plexus, and the findings were considered consistent with paracentral acute middle maculopathy, with acute macular neuroretinopathy in the differential diagnosis. No specific treatment exists, and care centers on systemic vascular risk assessment and follow-up. This case shows that the condition can occur in a young patient with modest vascular risk factors and may be diagnosed late.