Paracentral Acute Middle Maculopathy Associated with Arteritic Anterior Ischemic Optic Neuropathy in a Case of Giant Cell Arteritis

Background Giant cell arteritis (GCA) is a systemic granulomatous vasculitis, characterized by granulomatous inflammation of medium- and large-sized vessels that primarily affects the elderly and may result in ischemic injury to the optic nerve and retina. Arteritic anterior ischemic optic neuropathy (A-AION) with secondary permanent visual loss is the most common ocular complication of cranial GCA [ 1 ]. Recently, ischemic retinal lesions referred to as Paracentral Acute Middle Maculopathy (PAMM) have been described in GCA, either as an isolated finding or in association with A-AION [ 2 ]. First described by Sarraf et al. in 2013, PAMM is an OCT finding characterized by a hyperreflective band in the inner nuclear layer representing ischemia due to compromised perfusion of the intermediate and deep retinal capillary plexus [ 1 ], [ 3 ]. We report a case of an 81-year-old female with confirmed GCA exhibiting A-AION in association with PAMM and review the literature on PAMM as a specific OCT finding in A-AION and GCA. Publication History Received: 25 October 2025 Accepted: 02 December 2025 Article published online: 27 January 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany