Case Report: Transient monocular vision loss with isolated paracentral acute middle maculopathy on optical coherence tomography: beware of giant cell arteritis!

Introduction We describe a case of transient monocular vision loss (TMVL) and paracentral acute middle maculopathy (PAMM) on optical coherence tomography (OCT) as the only ocular presentation of biopsy-proven GCA. Case description An 80-year-old woman presented 4 days after an episode of TMVL in the right eye, which lasted for 2 hours and spontaneously resolved. She also had jaw claudication for 1 month. Visual acuity was 20/20 in both eyes, with no relative afferent pupillary defect. Funduscopic examination was normal. Humphrey visual fields (HVF 24-2) were full in both eyes. Spectral domain OCT of the right eye demonstrated a focal lesion with increased hyperreflectivity at the level of the inner nuclear layer, consistent with PAMM. Fluorescein angiography and indocyanine angiography were normal. She was immediately treated with intravenous steroids for presumed giant cell arteritis (GCA), confirmed subsequently by temporal artery biopsy. Conclusion Most reported GCA patients with PAMM have had permanent vision loss and other obvious funduscopic findings. This unique patient had only TMVL and a normal ophthalmologic examination, including full HVF, and no ischemia on retinal angiographic studies. Immediate macular OCT revealing PAMM in TMVL patients older than age 50 years should suggest GCA and prompt immediate treatment to prevent permanent vision loss.