DR. JYOTI KUMARI

DR. RAMANUJ SAMANTA, DR. SREERAM J

Abstract

A 21-year-old obese female presented with right eye (RE) acute paracentral scotoma for ten days along with headache for two months. The best-corrected visual acuity was 20/40 in RE and 20/20 in left eye. Anterior segment and intraocular pressures were normal bilaterally. Fundus revealed bilateral optic disc edema and RE wedge-shaped retinal opacification consistent with paracentral acute middle maculopathy (PAMM) on optical coherence tomography. Neurological evaluation, neuroimaging, and cerebrospinal fluid (CSF) analysis were unremarkable except elevated CSF opening pressure compatible with idiopathic intracranial hypertension (IIH). Optic disc edema and symptoms resolved following treatment with oral acetazolamide. We presume deep retinal capillary plexus ischemia secondary to the mechanical effect of disc edema probably contributed to IIH-associated PAMM lesion. This is a novel finding and has not been reported earlier in association with IIH.