Unmasking Systemic Disease through the Retina: A Case of Paracentral Acute Middle Maculopathy Leading to the Diagnosis of Diabetes Mellitus: Case Report
10.21561/jor.2025.10.2.272
- Author:
Hye Ji KWON
1
;
Mee Yon LEE
Author Information
1. Department of Ophthalmology, Uijeoungbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeoungbu, Korea
- Publication Type:CASE REPORT
- From:
Journal of Retina
2025;10(2):272-277
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:To report a case of paracentral acute middle maculopathy (PAMM) as the initial ocular finding that led to the diagnosis of previously unrecognized diabetes mellitus and to highlight the importance of systemic evaluation in patients presenting with PAMM.Case summary: A 42-year-old woman with no known systemic or ocular history presented with recent-onset paracentral visual disturbance in the right eye. Best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Fundus examination revealed subtle parafoveal whitish lesions in both eyes, and spectral-domain optical coherence tomography showed a hyperreflective band in the inner nuclear layer, consistent with PAMM. Wide-field fluorescein angiography demonstrated microaneurysms without significant nonperfusion, consistent with moderate non-proliferative diabetic retinopathy. Laboratory testing revealed an HbA1c level of 11.0%, confirming a new diagnosis of diabetes mellitus. Follow-up at three months showed partial resolution of PAMM lesions in both eyes. The patient was referred to endocrinology for systemic management, and regular ophthalmic monitoring was planned.
Conclusions:This case emphasizes the value of recognizing PAMM not only as a localized retinal ischemic event but also as a potential early marker of systemic microvascular disease. Prompt systemic evaluation in patients with PAMM can lead to early diagnosis and intervention for underlying conditions such as diabetes mellitus, contributing to better visual and systemic outcomes.
