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Peer-reviewedCC BY 4.0American Journal of Ophthalmology Case Reports

Diagnostic optical coherence tomography findings in arteritic posterior ischemic optic neuropathy: A case report

  • Andreas Worm Bendtsen1,2
  • Michael Stormly Hansen1,2
  • Bjarke Askaa3
  • Steffen Hamann1,2
  1. 1Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Denmark.
  2. 2Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  3. 3Department of Rheumatology and Spine Diseases, Bispebjerg - Frederiksberg Hospital, Denmark.
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Abstract

Purpose: To describe the finding of paracentral acute middle maculopathy (PAMM) in a patient with posterior ischemic optic neuropathy (PION) leading to the diagnosis of occult giant cell arteritis (GCA).

Case report: A 67-year-old man presented with sudden monocular vision loss. Ophthalmic examination revealed profound vision loss with an ipsilateral relative afferent pupillary defect, a cotton wool spot and PAMM on optical coherence tomography (OCT), while the optic disc appeared normal. Fluorescein and indocyanine green angiography revealed a perfusion deficit in the nasal choroid. There were no systemic symptoms and acute phase reactants were normal. Temporal artery biopsy was negative, while temporal artery ultrasound revealed definite signs of GCA. Accordingly, the final diagnosis of arteritic PION was made. At 9-month follow-up the optic disc was atrophic, and retinal ischemic perivascular lesions (RIPLs) had developed at the previous locations of PAMM.

Conclusion: PAMM on macular OCT may occasionally be the only indication of GCA in patients with sudden vision loss. Concurrent findings of PAMM and ischemic optic neuropathy in patients aged 50 and above should prompt urgent investigation for GCA and consideration of initiating treatment with high-dose corticosteroids, even without classic diagnostic features.

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Cite

BibTeXRIS
BibTeX
@article{bendtsen2026diagnostic,
  title = {{Diagnostic optical coherence tomography findings in arteritic posterior ischemic optic neuropathy: A case report}},
  author = {Andreas Worm Bendtsen and Michael Stormly Hansen and Bjarke Askaa and Steffen Hamann},
  journal = {American Journal of Ophthalmology Case Reports},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ajoc.2026.102691},
  url = {https://doi.org/10.1016/j.ajoc.2026.102691},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Diagnostic optical coherence tomography findings in arteritic posterior ischemic optic neuropathy: A case report
AU  - Andreas Worm Bendtsen
AU  - Michael Stormly Hansen
AU  - Bjarke Askaa
AU  - Steffen Hamann
PY  - 2026
DA  - 2026/10/14
JO  - American Journal of Ophthalmology Case Reports
DO  - 10.1016/j.ajoc.2026.102691
UR  - https://doi.org/10.1016/j.ajoc.2026.102691
AB  - Purpose: To describe the finding of paracentral acute middle maculopathy (PAMM) in a patient with posterior ischemic optic neuropathy (PION) leading to the diagnosis of occult giant cell arteritis (GCA).  Case report: A 67-year-old man presented with sudden monocular vision loss. Ophthalmic examination revealed profound vision loss with an ipsilateral relative afferent pupillary defect, a cotton wool spot and PAMM on optical coherence tomography (OCT), while the optic disc appeared normal. Fluorescein and indocyanine green angiography revealed a perfusion deficit in the nasal choroid. There were no systemic symptoms and acute phase reactants were normal. Temporal artery biopsy was negative, while temporal artery ultrasound revealed definite signs of GCA. Accordingly, the final diagnosis of arteritic PION was made. At 9-month follow-up the optic disc was atrophic, and retinal ischemic perivascular lesions (RIPLs) had developed at the previous locations of PAMM.  Conclusion: PAMM on macular OCT may occasionally be the only indication of GCA in patients with sudden vision loss. Concurrent findings of PAMM and ischemic optic neuropathy in patients aged 50 and above should prompt urgent investigation for GCA and consideration of initiating treatment with high-dose corticosteroids, even without classic diagnostic features.
SN  - 2451-9936
ER  -