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Ko, Jaesang MD*; Kwon, Oh W. MD, PhD*,†; Byeon, Suk H. MD, PhD*

doi: 10.1097/IAE.0000000000000054
Original Study

Purpose: To investigate the clinical features of central retinal vein occlusion (CRVO) in relation to the presence of a prominent middle limiting membrane (p-MLM) sign on presenting optical coherence tomography, which may suggest macular ischemia and poor visual outcome.

Methods: Fifty consecutive eyes with acute CRVO of <1 month of symptom duration before presentation were retrospectively reviewed. A hyperreflective line located in the outer plexiform layer (p-MLM) in optical coherence tomography was used as a sign of acute ischemia. Cases with p-MLM were grouped and compared with the group of eyes with no p-MLM sign (non-MLM group) for clinical features including visual acuities, central fovea thickness, and CRVO types.

Results: Among the 50 eyes, 14 (28%) eyes showed a p-MLM sign, 21 (42%) eyes did not, and others had equivocal findings. Eyes with p-MLM sign presented worse initial and final best-corrected visual acuity compared with the non-MLM group (1.10 ± 0.72 vs. 0.47 ± 0.49 logMAR in the initial best-corrected visual acuity, P = 0.007; and 1.08 ± 0.86 vs. 0.32 ± 0.41 logMAR in the final best-corrected visual acuity, P = 0.044) in patients with a follow-up duration of 6 months or longer. The p-MLM group eyes showed a higher tendency toward being classified as ischemic type CRVO (57.1 vs. 4.8%, P = 0.001).

Conclusion: Central retinal vein occlusion showing p-MLM on optical coherence tomography had worse visual outcome with higher incidence of being classified into ischemic type CRVO.

Central retinal vein occlusion patients with prominent middle limiting membrane sign on optical coherence tomography show poor initial and final visual outcome along with a higher propensity of ischemia.

*Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea; and

Nune Eye Hospital, Seoul, Korea.

Reprint requests: Suk H. Byeon, MD, PhD, Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea; e-mail:

Supported by the Conversing Research Center Program funded by the Ministry of Education, Science and Technology (2012K001354).

Paper presented in part at the 2013 Association for Research in Vision and Ophthalmology (ARVO) Annual meeting, Seattle, WA, May 2013.

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

Involved in the design of study (J.K., O.W.K., S.H.B.), Conduct of study (J.K., S.H.B.), Data collection (J.K., S.H.B.), Analysis and interpretation of data (J.K., O.W.K., S.H.B.), Statistical expertise (J.K.), Writing article (J.K.), and Critical revision of article (J.K., O.W.K., S.H.B.).

© 2014 by Ophthalmic Communications Society, Inc.