To assess microvascular blood flow of the deep retinal capillary plexus in eyes with paracentral acute middle maculopathy using optical coherence tomography (OCT) angiography.

Retrospective, multicenter observational case series.

Clinical and multimodal imaging findings from 8 patients with paracentral acute middle maculopathy were reviewed and analyzed. OCT angiography scans were analyzed and processed, and vessel density was calculated.

Eight patients (7 male, 1 female, aged 9–82 years) were included. OCT angiography was obtained at either the acute (4 cases) or old stage (4 cases). Scans of the deep capillary plexus showed preservation of perfusion in acute lesions and capillary attenuation in old cases. Cases of central retinal artery occlusion showed marked loss of the deep capillary plexus. The mean vessel density of the superficial capillary plexus in normal fellow eyes was 12.8 ± 1.8 mm⁻¹ vs 12.1 ± 1.9 mm⁻¹ in eyes with paracentral acute middle maculopathy (reduction −6.0%, P = .08). The mean vessel density of the deep capillary plexus in normal fellow eyes was 17.5 ± 1.4 mm⁻¹ vs 14.7 ± 3.5 mm⁻¹ in eyes with paracentral acute middle maculopathy (reduction −19.4%, P = .04). This significant difference was representative of the eyes with old lesions.

Paracentral acute middle maculopathy lesions correspond to preservation of perfusion in focal acute lesions and to pruning of the plexus in old cases. Cases of central retinal artery occlusion demonstrate marked hypoperfusion of the deep capillary plexus. Our study further supports an ischemic pathogenesis of this retinal vasculopathy.