Association of Chronic Paracentral Acute Middle Maculopathy Lesions with Hypertension

Ophthalmol Retina. 2020 May;4(5):504-509. doi: 10.1016/j.oret.2019.12.001. Epub 2019 Dec 16.


Purpose: To study changes in retinal microcirculation and the prevalence of chronic paracentral acute middle maculopathy (PAMM) lesions in patients with mild hypertension.

Design: Prospective cohort study.

Participants: Twenty-seven patients (21 men and 6 women; mean age, 50.3±6.3 years) with mild hypertension and with low cardiovascular risk and 24 healthy participants (15 men and 9 women; mean age, 46.3±13.0 years) were included.

Methods: The foveal avascular zone (FAZ) area and the vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were assessed using OCT angiography (OCTA). The presence of chronic PAMM lesions was evaluated for both eyes by the revision of cross-sectional OCT images of 6-mm volume scans. A chronic or resolved PAMM lesion was defined as inner nuclear layer thinning with outer plexiform layer (OPL) disruption.

Main outcome measures: Vessel density of the SCP and DCP and prevalence of chronic PAMM lesions.

Results: No difference was found between the hypertensive group and healthy group in demographic and clinical characteristics, vessel density of the SCP (48.9±2.4% and 47.8±2.0%, respectively; P = 0.92), vessel density of the DCP (54.1±3.3% and 54.0±1.8%, respectively; P = 0.93), or FAZ area (0.26±0.13 mm2 and 0.23±0.09 mm2, respectively; P = 0.37). Chronic PAMM lesions were found in 24 of 27 (88.9%) hypertensive patients and in 4 of 24 (16.7%) healthy individuals. The odds ratio for the presence of chronic PAMM lesions in patients with mild hypertension was 40.0 (P < 0.001).

Conclusions: Chronic PAMM lesions are highly prevalent in hypertensive patients and may represent the earliest changes in retinal microcirculation in patients with mild hypertension, before changes in OCTA parameters have become apparent.