Abstract
We thank Dr McLeod for his interest in our recent paper. 1 Falavarjani K.G. Phasukkijwatana N. Freund K.B. et al. En face optical coherence tomography analysis to assess the spectrum of perivenular ischemia and paracentral acute middle maculopathy in retinal vein occlusion. Am J Ophthalmol. 2017; 177: 131-138 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar As with a cotton-wool spot, “paracentral acute middle maculopathy (PAMM)” is a descriptive term referring to the characteristic optical coherence tomography (OCT) finding of a hyperreflective band at the level of the middle retina confined mainly to the inner nuclear layer (INL). 2 Sarraf D. Rahimy E. Fawzi A.A. et al. Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA Ophthalmol. 2013; 131: 1275-1287 Crossref PubMed Scopus (278) Google Scholar At the time of the original definition of PAMM, 2 Sarraf D. Rahimy E. Fawzi A.A. et al. Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA Ophthalmol. 2013; 131: 1275-1287 Crossref PubMed Scopus (278) Google Scholar its etiology was unknown and therefore the term was simply intended to be descriptive and agnostic regarding its cause. Several subsequent studies have identified ischemia at the level of the deep vascular complex as the etiology of this distinctive OCT finding, although the specific cellular mechanisms producing this change in tissue reflectivity are not completely understood. 3 Rahimy E. Kuehlewein L. Sadda S.R. Sarraf D. Paracentral acute middle maculopathy: what we knew then and what we know now. Retina. 2015; 35: 1921-1930 Crossref PubMed Scopus (113) Google Scholar , 4 Nemiroff J. Kuehlewein L. Rahimy E. et al. Assessing deep retinal capillary ischemia in paracentral acute middle maculopathy by optical coherence tomography angiography. Am J Ophthalmol. 2016; 162: 121-132 Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein OcclusionAmerican Journal of OphthalmologyVol. 182PreviewUsing en face optical coherence tomography (OCT), Falavarjani and associates recently illustrated the variability in the area of macular middle-retinal infarction (MMRI) exhibited in eyes with subtotal central retinal venous or arterial occlusion (CRVO or CRAO).1 The severity spectrum from narrow perivenular MMRI to diffuse MMRI with periarteriolar sparing was thought to reflect the extent of circulatory failure during infarct evolution. This chimes with funduscopic observations going back 40 years. Full-Text PDF
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