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Maculopathie moyenne aigue paracentrale : un signe spécifique de neuropathie optique ischémique antérieure artéritique

Acute anterior ischemic optic neuropathy (AION) is a common cause of visual impairment, often affecting elderly individuals. Early diagnosis is crucial to differentiate between arteritic (A-AION) linked to giant cell arteritis (GCA) and nonarteritic (NA-AION) forms. Distinguishing between these forms is vital for prompt corticosteroid treatment to prevent A-AION from becoming bilateral. Signs such as central retinal artery occlusion, cilioretinal artery occlusion, and pale optic disc help in differentiation. A retrospective study found paracentral acute middle maculopathy (PAMM) common in GCA-associated A-AION, emphasizing its importance for diagnosis. The main purpose of this study is to further investigate the sensitivity, specificity, positive, and negative predictive values of the presence of PAMM in a patient with AION as a sign of GCA.

The study retrospectively reviewed patients with AION at a French hospital from January 2018 to March 2022. Patients diagnosed with AION and having undergone comprehensive eye examinations with optical coherence tomography (OCT) imaging at disease onset were included, following the American College of Rheumatology criteria for diagnosing GCA. OCT images were analyzed for the presence of hyper-reflectivity in the inner nuclear layer (PAMM) by three independent retinal disease experts. The study aimed to assess sensitivity, specificity, and predictive values for PAMM as a diagnostic marker for GCA.

PAMM were only found in the A-AION group (N = 4) (P = .0143). As a distinctive sign of A-AION, we found a specificity of 100% (95% IC, 88.06%-100%) and a positive predictive value of 100%. In contrast, sensitivity and negative predictive value were lower, 19.1% (95% IC, 5.5-42.0) and 63.0% (95% CI, 58.1-67.7), respectively.

This study found that Paracentral Acute Middle Maculopathy (PAMM) is highly specific to arteritic anterior ischemic optic neuropathy (A-AION). While PAMM had excellent specificity and positive predictive value for GCA, sensitivity and negative predictive value were low. The research suggests that PAMM can serve as a diagnostic tool, not for screening. 

Furthermore, the study proposes the use of macular OCT for patients with GCA or AION to detect PAMM as an additional diagnostic marker for GCA. However, larger-scale studies are needed to confirm these findings.

Our study emphasized the high specificity and positive predictive value of PAMM in indicating the presence of GCA in cases of AION. Based on these findings, we recommend conducting macular OCT to detect PAMM in any patient with AION. Further research is necessary to validate our outcomes.