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A middle hyper-reflective band on spectral domain optical coherence tomography in a case of acute nonarteritic central retinal artery occlusion with sparing of cilioretinal artery

Bansal, Nishat; Bansal, Rakesh K1

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Indian Journal of Ophthalmology: August 2019 - Volume 67 - Issue 8 - p 1345
doi: 10.4103/ijo.IJO_2138_18
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An 80-year-old female presented with sudden decreased vision in the right eye (RE) since 6 h. Posterior segment examination of RE showed signs suggestive of nonarteritic central retinal artery occlusion (CRAO) with sparing of cilioretinal artery (CLRA) [Fig. 1a and b]. Spectral domain optical coherence tomography (SD OCT) done in macular area showed a middle hyper-reflective band (MHB) in the temporal perifoveal area and increased reflectivity of the inner retinal layers suggestive of ischemia.[12] The nasal perifoveal area showed normal inner retinal structure, without MHB, suggesting sparing of CLRA [Fig. 1c]. The presence of MHB on SD OCT can aid in the diagnosis and provide prompt and noninvasive clue to the diagnosis of acute CRAO with sparing of ciliroretinal artery (CLRA).

Figure 1
Figure 1:
Color fundus photo (a) and red free (b) showing retinal whitening suggestive of CRAO and CLRA (red arrows). The Corresponding OCT (c) passing through the fovea (green arrow- Fig. 1a) shows hyper-reflectivity of inner retina layers and MHB on temporal perifoveal area (black arrow- Fig. 1c) and normal inner retinal architecture nasal to fovea with absence of MHB

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

1. Feucht N, Zapp D, Reznicek L, Lohmann CP, Maier M, Mayer CS. Multimodal imaging in acute retinal ischemia: Spectral domain OCT, OCT-angiography and fundus autofluorescence Int J Ophthalmol. 2018;11:1521–7
2. Chu YK, Hong YT, Byeon SH, Kwon OW. In vivo detection of acute ischemic damages in retinal arterial occlusion with optical coherence tomography: A “prominent middle limiting membrane sign” Retina. 2013;33:2110–7
© 2019 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow