title: The spectrum of superficial and deep capillary ischemia in retinal artery occlusion.
abstract: OBJECTIVE
  To describe the spectrum of retinal capillary ischemia, including superficial and deep capillary ischemia, as identified with spectral-domain optical coherence tomography (SD OCT), that occurs in retinal arterial occlusive disease.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Clinical charts, color fundus photography, red-free fundus photography, fluorescein angiography, near-infrared reflectance, and SD OCT imaging in 40 eyes of 35 patients with retinal arterial occlusive disease were studied in both the acute and chronic phases in multicenter clinical practices. SD OCT imaging analysis was employed to characterize the presence of superficial and deep capillary ischemia in each eye.
  
  
  RESULTS
  Of the 40 eyes, 15 eyes had central retinal artery occlusion (CRAO), 22 eyes had branch retinal artery occlusion (BRAO), and 3 eyes had cilioretinal artery occlusion. During the acute phase, SD OCT showed the following 3 distinct patterns, related to retinal ischemia occurring at varying levels within the retina: (1) thickening and hyperreflectivity of the inner retinal layers, including the nerve fiber and ganglion cell layers owing to ischemia of the superficial capillary plexus; (2) a hyperreflective band at the level of the inner nuclear layer, termed "paracentral acute middle maculopathy," representing ischemia of the intermediate and deep retinal capillary plexuses (deep capillary ischemia); and (3) diffuse thickening and hyperreflectivity of both the inner and middle retinal layers, which represented both superficial and deep capillary ischemia. Of all eyes, 31 (78%) had both superficial and deep lesions. The remaining 9 eyes (22%) had isolated deep capillary ischemia producing paracentral acute middle maculopathy with sparing of the superficial capillary plexus and a normal fluorescein angiographic appearance. As the lesions evolved into the chronic phase over the ensuing 3 months, the resultant thinning and atrophy reflected the retinal layers affected during the acute phase.
  
  
  CONCLUSIONS
  SD OCT imaging reveals the spectrum of capillary ischemia in retinal artery occlusive disease showing variable involvement of the superficial and intermediate/deep capillary plexuses. Isolated deep capillary ischemia manifested as paracentral acute middle maculopathy on SD OCT and may be seen in some eyes with retinal arterial circulation compromise despite complete absence of perfusion abnormalities on fluorescein angiography.
authors.affiliation: Department of Ophthalmology, Shanghai Jiaotong University Affiliated Shanghai First People's Hospital, Shanghai, China; Vitreous, Retina, Macula Consultants of New York, New York, New York.
authors.forename: Suqin
authors.initials: S
authors.lastname: Yu
authors.affiliation: Vitreous, Retina, Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, New York.
authors.forename: Claudine E
authors.initials: CE
authors.lastname: Pang
authors.affiliation: Department of Ophthalmology, Shanghai Jiaotong University Affiliated Shanghai First People's Hospital, Shanghai, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Gong
authors.affiliation: Vitreous, Retina, Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, New York; New York University School of Medicine, Department of Ophthalmology, New York, New York.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.affiliation: Vitreous, Retina, Macula Consultants of New York, New York, New York; Columbia University School of Medicine, Department of Ophthalmology, New York, New York.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
authors.affiliation: Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Rahimy
authors.affiliation: West Coast Retina Medical Group, San Francisco, California.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Lujan
authors.affiliation: Retina Vitreous Association Medical Group, Los Angeles, California.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Tabandeh
authors.affiliation: Vitreous, Retina, Macula Consultants of New York, New York, New York.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cooney
authors.affiliation: Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, University of California, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California. Electronic address: dsarraf@ucla.edu.
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002196:Capillaries / Q000473:pathology*; D002908:Chronic Disease; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015356:Retinal Artery Occlusion / Q000473:pathology*; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D055815:Young Adult