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

## TL;DR

An 80-year-old woman with transient vision loss and a specific OCT finding was diagnosed with giant cell arteritis, highlighting the importance of early detection.

## Contribution

This case highlights PAMM on OCT as a rare, early indicator of GCA without typical ocular signs.

## Key findings

- PAMM on OCT was the only ocular sign of GCA in a patient with transient vision loss.
- The patient had no permanent vision loss or ischemia on retinal angiography.
- Immediate treatment with steroids prevented further complications.

## Abstract

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.

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.

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.