The optical imaging of idiopathic paracentral acute middle maculopathy in a Chinese young man and review of the literature

We report a case of idiopathic paracentral acute middle maculopathy with typical optical imaging and clinical features. A 26-year-old Chinese policeman presented with a 20-day history of paracentral scotoma in the left eye after early wake-up and long-time working in front of computer the day before. He experienced sudden-onset strong flash in his left eye. Paracentral scotoma appeared in his left eye after 6 hours of rest. The general history was negative. His best corrected visual acuity was 20/20 OU. Anterior segment, dilated fundus examination, papillary evaluation and intraocular pressure were normal. Fuorescein angiography and blue light fundus auto fluorescence showed no significant abnormality. In multicolor photography, the lesion was visible on the monochromic infrared/blue reflectance images and not clear in green reflectance. The 10 degree visual field examination revealed superior paracentral relative scotoma. Multifocal electroretinogram revealed reduced response in central area in the left eye. Spectral-domain optical coherence tomography showed that hyperreflective plaque was present at the IPL/INL/OPL level with hyperreflective point at the GCL. The plaque became thinner 3 months later and diminished 6 months later with obviously atrophied INL. In the 3 months follow-up, transverse scan revealed that there was a well-demarcated hypo-refractive lesion in IPL and hyper-refractive lesion in INL. OCTA revealed the deceased flow signal intensity of focal deep capillaries. En face OCT imaging of the left eye revealed a relative well-defined, hypo-refractive lesion and non-flow area localized at the level of the deep capillary plexus.