Original StudyIN VIVO DETECTION OF ACUTE ISCHEMIC DAMAGES IN RETINAL ARTERIAL OCCLUSION WITH OPTICAL COHERENCE TOMOGRAPHY A “Prominent Middle Limiting Membrane Sign”Chu, Young Kwang MD*,†; Hong, Young Taek MD*; Byeon, Suk Ho MD*; Kwon, Oh Woong MD*Author Information *Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea †Siloam Eye Hospital, Seoul, Korea Reprint requests: Suk Ho Byeon, MD, Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, Seoul 120-752, Korea; e-mail: [email protected] Y.K.C. and Y.T.H. contributed equally to this work. Supported by the Conversing Research Center Program funded by the Ministry of Education, Science and Technology (Grant No. 2011K000680) and a faculty research grant of Yonsei University College of Medicine for 2009 (Grant No. 6-2009-0078). The authors have no financial interests to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com). Retina: November/December 2013 - Volume 33 - Issue 10 - p 2110-2117 doi: 10.1097/IAE.0b013e3182899205 Buy SDC Metrics AbstractIn Brief Purpose: To describe characteristic findings of acute retinal ischemic damage in optical coherence tomography. Methods: Eighteen cases of acute retinal arterial occlusion with available fundus photography, optical coherence tomography, and/or fluorescein angiography in the early phase (<1 month) with more than 2 months follow-up were reviewed. A site-to-site analysis between optical coherence tomography morphology and correlating fundus images were done on each visit. Results: Retinal opacities at first presentation were vague to mild opacity in four eyes, moderate (affecting visibility of underlying choroidal vessels) in seven, severe (yellow to whitish) in five, and very severe (chalky white) in two. These changes eventually disappear within 1 month (8 of 9 eyes). Inner retinal hyperreflectivity and a “prominent middle limiting membrane” in optical coherence tomography were consistently noticed up to 1 month showing regional correlation with the retinal opaque areas and was readily identified even in areas with vague or disappeared retinal opacities. Later, inner retinal atrophic changes replace these ischemic optical coherence tomography signs. Conclusion: A prominent middle limiting membrane sign is a useful indicator of acute ischemic retinal damage, especially in cases showing subtle or resolved retinal opacities before the onset of atrophic changes. A characteristic optical coherence tomography finding (prominent middle limiting membrane sign and inner retinal hyperreflectivity) in acute obstructive arterial disease is valuable for diagnosing ischemic damage areas. © 2013 by Ophthalmic Communications Society, Inc.