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

Abstract

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. 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. 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). 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.