Copyright@ Hooshang Faghihi | Biomed J Sci & Tech Res | BJSTR. MS.ID.003604. 15896 Case Report ISSN: 2574 -1241 Cilioretinal Artery Hypoperfusion in Association with Paracentral Acute Middle Maculopathy: A Case Report and Review of Literature Elias Khalili Pour, Hamid Riazi Esfahani, Shahin Faghihi and Hooshang Faghihi* Eye research center, Farabi Eye Hospital, Iran *Corresponding author: Hooshang Faghihi, Assistant professor of ophthalmology , Vitreoretinal Fellowship Eye Research Center, Farabi Eye Hospital, Iran DOI: 10.26717/BJSTR.2019.21.003604 Introduction Paracentral acute middle maculopathy (PAMM) has been described as an independent entity or accompanied by other retinal vascular diseases like diabetic retinopathy, retinal vein occlusion, retinal artery occlusion and with the consumption of vasoconstrictors like caffeine and epinephrine [1,2]. In this report we present a case of cilioretinal artery hypoperfusion and PAMM in the border of the affected ischemic retinal area and will review the literature that showed the vulnerability of deep capillary plexus to the ischemic conditions. Case Report A 47- year-old man was referred to retina ward of Farabi eye hospital with the complaint of scotoma in front of the right eye since 2 days ago upon awakening in the morning. He was a nonsmoker diabetic patient under treatment with Metformin. He was hypertensive and with consumption of 50 milligrams daily Losartan, blood pressure was under control. He did not suffer from migraine and other types of headaches, recent traumatic history, abnormal caffeine intake, phosphodiesterase-5 (PDE-5) inhibitor consumption at bedtime and so on. Best-corrected visual acuity was 20/20 in both eyes. Anterior segment examination was unremarkable. Fundus evaluation of the right eye showed a yellow-white well-defined lesion in the distribution of the cilioretinal artery (Figures 1A & 1B). Left eye fundus evaluation was normal (Figure 1C). SD-OCT through the lesion (Figures 1D & 1E) demonstrated a placoid, hyperreflective band at the level of the inner and middle retinal layers consistent with cilioretinal artery hypoperfusion and at the lower border of the lesion this hyperreflective band was just at the level of middle retina (inner nuclear layer) consistent with paracentral acute middle maculopathy with extension into the inner plexiform layer. Fundus autofluorescence showed hypo autofluorescence at the level of lesion (Figure 1F). OCT Angiography with En face projection (Figure 1G) at the level of the deep capillary plexus showed a gross capillary loss with visibility of superficial retinal vessels seen as projection artifacts. OCTA of the left eye was normal (Figure 1H). Received: September 12, 2019 Published: September 19, 2019 Citation: Elias Khalili Pour, Hamid Riazi Esfahani, Shahin Faghihi, Hooshang Faghihi. Cilioretinal Artery Hypoperfusion in Association with Paracentral Acute Middle Maculopathy: A Case Report and Review of Literature. Biomed J Sci & Tech Res 21(3)-2019. BJSTR. MS.ID.003604. ARTICLE INFO Abstract We report a case of unilateral cilioretinal artery hypoperfusion with 20/20 visual acuity accompanied by paracentral acute middle maculopathy in the marginal zones of the ischemic area. Multimodal imaging of the patient including fundus autofluorescence, spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) was done. In this case, we demonstrated the most noteworthy susceptibility of the retina to hypoperfusion at the level of the deep capillary plexus. Abbreviations: SD-OCT: Spectral-Domain Optical Coherence Tomography; OCTA: Optical Coherence Tomography Angiography; PAMW: Paracentral Acute Middle Maculopathy; PDE-5: Phosphodiesterase-5; PAMM: Paracentral Acute Middle Maculopathy