Rahimy Ehsan, Sarraf David, Dollin Michael L, Pitcher John D, Ho Allen C
Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California.
Am J Ophthalmol. 2014 Aug;158(2):372-380.e1. doi: 10.1016/j.ajo.2014.04.024. Epub 2014 May 1.
To better characterize a novel spectral-domain optical coherence tomography (OCT) presentation, termed paracentral acute middle maculopathy, to describe this finding in patients with nonischemic central retinal vein occlusion (CRVO), and to support a proposed pathogenesis of intermediate and deep retinal capillary ischemia.
Retrospective observational case series.
Clinical histories, high-resolution digital color imaging, red-free photography, fluorescein angiography, near-infrared reflectance, and spectral-domain OCT images of 484 patients with acute CRVO from 2 centers were evaluated for the presence of coexisting paracentral acute middle maculopathy.
Of 484 patients diagnosed with CRVO, 25 (5.2%) demonstrated evidence of concurrent paracentral acute middle maculopathy. Patients averaged 51 years of age and presented with complaints of paracentral scotomas. All patients demonstrated hyper-reflective plaquelike lesions at the level of the inner nuclear layer by spectral-domain OCT and showed corresponding dark-gray lesions on near-infrared reflectance and perivenular deep retinal whitening on color fundus photography. There was no fluorescein angiographic correlate to these lesions. On follow-up spectral-domain OCT imaging, the lesions had resolved into areas of inner nuclear layer atrophy with persistence of scotomas.
Paracentral acute middle maculopathy refers to characteristic hyper-reflective spectral-domain OCT lesions involving the middle layers of the retina at the level of the inner nuclear layer that may develop in response to ischemia of the intermediate and deep capillary plexuses. This series is the largest to describe this spectral-domain OCT finding to date, and it is the first to associate it with nonischemic CRVO.
更好地描述一种新型的光谱域光学相干断层扫描（OCT）表现，即黄斑中心凹旁急性中层病变，描述非缺血性视网膜中央静脉阻塞（CRVO）患者的这一发现，并支持提出的视网膜中层和深层毛细血管缺血的发病机制。
回顾性观察病例系列。
对来自2个中心的484例急性CRVO患者的临床病史、高分辨率数字彩色成像、无赤光摄影、荧光素血管造影、近红外反射成像和光谱域OCT图像进行评估，以确定是否存在并存的黄斑中心凹旁急性中层病变。
在484例诊断为CRVO的患者中，25例（5.2%）有并发黄斑中心凹旁急性中层病变的证据。患者平均年龄51岁，主诉黄斑中心凹旁暗点。所有患者经光谱域OCT检查在内核层水平均显示高反射斑块样病变，在近红外反射成像上显示相应的暗灰色病变，在彩色眼底照片上显示静脉周围视网膜深层变白。这些病变与荧光素血管造影无相关性。在随访的光谱域OCT成像中，病变已演变为内核层萎缩区域，暗点持续存在。
黄斑中心凹旁急性中层病变是指在内核层水平累及视网膜中层的特征性高反射光谱域OCT病变，可能是对中层和深层毛细血管丛缺血的反应而发生。本系列是迄今为止描述这一光谱域OCT发现的最大样本，也是首次将其与非缺血性CRVO相关联。
