In vivo detection of acute ischemic damages in retinal arterial occlusion with optical coherence tomography: a "prominent middle limiting membrane sign".

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.