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Yu, Suqin MD*,†; Wang, Fenghua MD*; Pang, Claudine E. MD†,‡; Yannuzzi, Lawrence A. MD†,‡,§; Freund, K. Bailey MD†,‡

doi: 10.1097/IAE.0000000000000048
Original Study

Purposes: To evaluate the multimodal imaging findings in retinal deep capillary ischemia (DCI).

Methods: This was a retrospective review of 5 eyes of 4 patients with sudden onset of paracentral scotomas caused by DCI. Multimodal imaging techniques, including color and red-free photographs, near-infrared reflectance, fluorescein angiography, and spectral-domain optical coherence tomography, were performed in all eyes, and the findings were correlated with microperimetry in two eyes. Imaging findings in DCI were compared with those of a cotton wool spot caused by superficial capillary ischemia (SCI).

Results: Unlike SCI, the imaging findings in DCI were subtler during both the acute and chronic phase, but specific optical coherence tomographic findings could readily differentiate these entities. Acute SCI showed inner retinal whitening, edema, and increased reflectivity, whereas acute DCI showed increased reflectivity of middle retinal layers. Chronic DCI showed retinal thinning with middle layer atrophy, whereas chronic SCI showed inner layer atrophy. In one patient, microperimetry showed a paracentral dense scotoma that corresponded well to the optical coherence tomographic findings.

Conclusion: Deep capillary ischemia may represent a nonspecific finding of retinal ischemia and produces characteristic changes within the middle retinal layers, analogous to a deep cotton wool spot, but with distinct features differing from the superficial cotton wool spot which is seen in SCI. Among the various multimodal imaging techniques, optical coherence tomography seemed to be the most sensitive and specific technique in detecting DCI in both the acute and chronic phases.

We report the multimodal imaging findings observed in eyes with retinal deep capillary ischemia. Of the various imaging techniques used to study these eyes, optical coherence tomography seemed to be the most sensitive and specific technique in detecting deep capillary ischemia in both the acute and chronic phases.

*Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China;

Vitreous-Retina-Macula Consultants of New York, New York, NY;

LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, NY; and

§Columbia University School of Medicine, New York, NY.

Reprint requests: K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor New York, NY 10022; e-mail:

Supported by K. C. Wong Education Foundation, Hong Kong, LuEsther T. Mertz Retinal Research Center, New York, NY, and The Macular Foundation, Inc.

None of the authors have any financial/conflicting interests to disclose.

© 2014 by Ophthalmic Communications Society, Inc.