A rare manifestation of radiation retinopathy – Paracentral acute middle maculopathy

Paracentral acute middle maculopathy (PAMM) was originally described as a band-like hyperreflectivity of the inner nuclear layer in optical coherence tomography. In 2013, it has been documented to occur in association with a variety of systemic, retinal vascular and ocular diseases. Radiation retinopathy is a microangiopathy occurring in individuals receiving ionizing radiation above a dose range of 2500–3000 cGy presenting 6 months to 3-year post-exposure. Radiation-induced endothelial cell damage causes vascular occlusion and leakage, commonly presenting with microaneurysms, cotton wool spot, neovascularization and macular oedema. The incidence of radiation retinopathy has been documented from 3.1% to as high as 85.7% in literature following external beam radiotherapy (EBRT) to the head and neck region. In this case report, we present a case with PAMM as a manifestation of radiation retinopathy following external beam radiotherapy for carcinoma of tongue with metastasis.