title: En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein Occlusion.
abstract: OBJECTIVE
  To assess the spectrum of perivenular ischemia in eyes with retinal vascular obstruction (typically central or hemicentral retinal vein obstruction) using en face optical coherence tomography (OCT).
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Eyes with recent retinal vascular occlusion illustrating paracentral acute middle maculopathy (PAMM) in a perivenular fern-like pattern with en face OCT were evaluated in this study. Multimodal retinal imaging including en face OCT segmentation of the inner nuclear layer was performed in all patients. Color fundus photography and fluorescein angiography (FA) images were used to create a vascular overlay of the retinal veins vs the retinal arteries to map the distribution of PAMM with en face OCT analysis.
  
  
  RESULTS
  Multimodal retinal imaging was performed in 11 eyes with acute retinal vascular obstruction. While 7 eyes demonstrated obvious findings of retinal vein obstruction (5 with central and 2 with hemicentral retinal vein occlusion), 4 eyes were unremarkable at presentation. En face OCT analysis demonstrated a spectrum of perivenular PAMM illustrating a fern-like pattern with sparing of the periarteriolar area in all cases.
  
  
  CONCLUSIONS
  En face OCT may illustrate a remarkable perivenular pattern of PAMM in eyes with retinal vascular obstruction even in the absence of significant funduscopic findings. Perivenular PAMM with en face OCT demonstrates a wide spectrum of variation with narrow fern-like perivenular lesions at the mildest end and more diffuse lesions with only periarterial sparing at the most severe end of the spectrum. Arterial hypoperfusion secondary to outflow obstruction from a central retinal vein obstruction appears to be the most common cause of this presentation, although primary arterial hypoperfusion may also be an etiology.
authors.affiliation: Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California Los Angeles, Los Angeles, California; Stein Eye Institute, University of California Los Angeles, Los Angeles, California; Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Khalil
authors.initials: K
authors.lastname: Ghasemi Falavarjani
authors.affiliation: Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Stein Eye Institute, University of California Los Angeles, Los Angeles, California; Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Nopasak
authors.initials: N
authors.lastname: Phasukkijwatana
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.affiliation: Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California; The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California; West Coast Retina Medical Group, San Francisco, California.
authors.forename: Emmett T
authors.initials: ET
authors.lastname: Cunningham
authors.affiliation: Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; West Coast Retina Medical Group, San Francisco, California.
authors.forename: Ananda
authors.initials: A
authors.lastname: Kalevar
authors.affiliation: Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; West Coast Retina Medical Group, San Francisco, California.
authors.forename: H Richard
authors.initials: HR
authors.lastname: McDonald
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York.
authors.forename: Rosa
authors.initials: R
authors.lastname: Dolz-Marco
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Philipp K
authors.initials: PK
authors.lastname: Roberts
authors.affiliation: Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California Los Angeles, Los Angeles, California; Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
authors.forename: Irena
authors.initials: I
authors.lastname: Tsui
authors.affiliation: Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Rosen
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Jampol
authors.affiliation: Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California Los Angeles, Los Angeles, California.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Sadda
authors.affiliation: Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Stein Eye Institute, University of California Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California. Electronic address: sarraf@jsei.ucla.edu.
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000473:pathology; D005654:Fundus Oculi; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology; D012169:Retinal Vein / Q000473:pathology*; D012170:Retinal Vein Occlusion / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity; D055815:Young Adult