Review on day one post uneventful phacoemulsification surgery is no longer standard practice due to the infrequency of complications when using modern cataract removal techniques. Clinicians are therefore likely to be unfamiliar with the potential causes of reduced vision when presented with a patient in the immediate postoperative period. The purpose of this review is to discuss the various differential causes of early visual loss, for the benefit of clinicians presented with similar patients in emergency care, with the use of an illustrative clinical case of paracentral acute middle maculopathy (PAMM), which recently presented to the authors. A thorough literature search on Google Scholar was conducted, and only causes of visual loss that would manifest within 24 h postoperatively were included. Complications are inherently rare in this period; however, various optical, anterior segment, lens-related and posterior segment causes have been identified and discussed. Front-line clinicians should be aware of these differentials with different mechanisms. PAMM remains to be the only cause of unexpected visual loss within this time frame that may have no abnormal findings on clinical examination.

/pdf/unexpected-poor-vision-within-24-h-of-uneventful-2xm9ah2p.pdf

Unexpected Poor Vision within 24 h of Uneventful Phacoemulsification Surgery—A Review

https://doi.org/10.1016/j.ajoc.2023.101857

The spectrum of COVID-19-associated chorioretinal vasculopathy

Purpose: To present a case of sequential paracentral acute middle maculopathy (PAMM) in a middle-aged woman with no cardiovascular risk factors. Methods: A single case was evaluated. Results: A 53-year-old woman with a history of PAMM resulting from perfused central retinal artery occlusion in the left eye presented with PAMM in the right eye 3 years later. The patient had a medical history of treated anemia, stress disorder, and insomnia. Examination of the right eye showed a superior parafoveal crescent of translucent retina without associated edema or hemorrhage. Optical coherence tomography (OCT) showed hyperreflective band-like areas in the superior parafoveal and perifoveal regions. Fluorescein angiography revealed normal arterial filling. OCT angiography showed patchy filling of the middle capillary plexus with normal perfusion of the superficial capillary plexus in the right eye. Conclusions: Although bilateral sequential PAMM is rare, close monitoring in a case of PAMM in 1 eye should be considered.

Sequential Bilateral Paracentral Acute Middle Maculopathy in a Middle-Aged Woman

Purpose: To review the demographic and clinical profile of patients developing acute macular neuroretinopathy (AMN) or paracentral acute middle maculopathy (PAMM) after receiving coronavirus disease-2019 (COVID-19) vaccination or infection. Methods: In this review article, the published literature was searched to determine cases developing either AMN or PAMM after COVID-19 vaccinations or infections. Data, including demographic profile, presenting features, symptoms, diagnosis, and clinical outcomes, were extracted from the selected publications. These parameters were compared between the two groups, i.e., patients developing AMN/PAMM either after vaccination or infection. Results: After the literature review, 57 patients developing either AMN (n = 40), PAMM (n = 14), or both (n = 3) after COVID-19 infection (n = 29) or vaccination (n = 28) were included (mean age: 34.9 ± 14.4 years; n = 38; 66.7% females). In 24.6% patients, the diagnosis of COVID-19 infection was preceded by the development of ocular disease. There were no significant differences in the age or gender between the patients developing AMN or PAMM after vaccination or infection (p > 0.13). Among the vaccination group, the highest number of patients developing AMN/PAMM were after the Oxford-AstraZeneca (n = 12; 42.9%). Patients with vaccination had a significantly early onset of AMN/PAMM compared to those with infection (11.5 ± 17.6 days versus 37.8 ± 43.6 days; p = 0.001). Conclusions: Both AMN and PAMM are reported to be associated with COVID-19 infections and in persons receiving vaccination against COVID-19. While COVID-19 infections and vaccinations may have a contributory role, other risk factors such as oral contraceptive pills may also play a role in the development of the disease.

/pdf/acute-macular-neuroretinopathy-and-paracentral-acute-middle-31dt4rxa.pdf

Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy during SARS-CoV-2 Infection and Vaccination

A 2‐week‐old infant with a large vascular birthmark involving her right face presented with right‐sided facial paralysis. MRI of the brain revealed multiple intracranial hemangiomas, and the hemangioma within the right temporal bone impinged on the facial nerve, which resulted in paralysis. Cranial nerve palsies are a rare neurological manifestation of PHACE syndrome. We report successful treatment of the facial nerve palsy with oral propranolol.

Intracranial hemangioma‐associated cranial nerve VII palsy treated with propranolol in an infant with possible PHACE syndrome

A 28-year-old man was admitted to hospital for surgical repair of a distal femur fracture sustained during a road traffic accident. Recovery was complicated by a pulmonary embolism. Two days later, his respiratory status declined, and he was transferred to intensive care unit (ICU) for ventilatory support due to confirmed SARS-CoV-2 infection.

He reported bilateral reduced vision after being discharged from ICU. Visual acuities were 6/18 right and 6/12 left. Dilated funduscopy revealed bilateral cotton wool spots and small, sparse mid-peripheral intraretinal haemorrhages (figure 1). Discrete areas of retinal pallor involving the fovea were consistent with paracentral acute middle maculopathy (PAMM), confirmed on optical coherence tomography (OCT) (figure 2).



Figure 1 
Fundus autofluorescence of the right eye (A) and left eye (B) showing bilateral cotton wool spots …

https://pmj.bmj.com/content/postgradmedj/early/2021/06/30/postgradmedj-2021-140500.full.pdf

Bilateral paracentral acute middle maculopathy in a SARS-CoV-2-positive patient.

Infantile hemangiomas are common benign vascular tumors but are rarely found in an intracranial location. Our literature review identified 41 reported cases. There is no general consensus on management of these rare lesions and until recently, treatment was limited to surgery or pharmacological management with steroids or interferon. Although beta-blockers have been widely prescribed in the treatment of cutaneous infantile hemangiomas since 2008, their use in the treatment of intracranial infantile hemangiomas has been minimal. We present a case of infantile hemangioma affecting the right orbit, associated with intracranial extension, causing intermittent right facial nerve palsy. The patient achieved an excellent outcome following combined treatment with oral propranolol and topical timolol maleate 0.5%, with complete regression of the lesion by 4 months. We conclude that beta-blockers are a safe and effective treatment of intracranial infantile hemangiomas and can be employed as first-line management of these lesions.

https://www.mdpi.com/2036-7503/13/3/43/pdf

Aoife Naughton

Papers

Bilateral paracentral acute middle maculopathy in a SARS-CoV-2-positive patient.

Safe and Effective Treatment of Intracranial Infantile Hemangiomas with Beta-Blockers.