Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) associated with Paracentral Acute Middle Maculopathy (PAMM) and Cilioretinal Artery Occlusion (CILRAO): multimodal imaging of a newly described clinical association

Purpose:The purpose of this study was to report multimodal imaging features of a novel association of nonarteritic anterior ischemic optic neuropathy, paracentral acute middle maculopathy, and cilioretinal artery occlusion.Methods:A 74-year-old male patient presented complaining of an acute subjective decline in visual acuity in the right eye over the previous days. This patient underwent a comprehensive ophthalmologic assessment, including multimodal retinal imaging and visual field test.Results:The eye examination revealed yellowish optic disk edema in the right eye with peripapillary hemorrhages and a whitish lesion extending from the temporal margin of the optic nerve head toward the macula. Multimodal imaging confirmed the diagnosis of nonarteritic anterior ischemic optic neuropathy in the right eye. Notably, the structural B-scan and en face optical coherence tomography images revealed hyperreflective areas in the inner and mid retinal layers, indicating an association with cilioretinal artery occlusion and paracentral acute middle maculopathy.Conclusion:The authors herein describe the clinical findings of a previously unreported association among nonarteritic anterior ischemic optic neuropathy, cilioretinal artery occlusion, and paracentral acute middle maculopathy.