Patchy ischemic retinal whitening in acute central retinal vein occlusion.

OBJECTIVE

To describe a new fundus abnormality in nonischemic central retinal vein occlusion and its pathophysiologic basis.

DESIGN

Retrospective, observational case series.

PARTICIPANTS

Eleven consecutive patients from a community-based retina referral practice who had central retinal vein occlusion (CRVO) and patchy ischemic retinal whitening (PIRW) and 225 consecutive patients from the same practice with CRVO and no PIRW.

RESULTS

Patchy ischemic retinal whitening occurs in younger patients with nonischemic CRVO (P < 0.0003) and is associated with better visual outcomes than without PIRW (P = 0.0201). Patchy ischemic retinal whitening has a perivenular distribution in the macula, has no fluorescein angiographic correlate in milder cases, can occur before any retinal hemorrhages or macular edema, and resolves in 2 to 4 weeks. Cilioretinal arteriolar insufficiency is a common finding associated with PIRW (5/11 cases). The laboratory evaluation of patients with PIRW is generally normal.

CONCLUSIONS

Patchy ischemic retinal whitening is a useful fundus sign of nonischemic CRVO that can precede other signs. Familiarity with this sign and its correlates will allow accurate diagnosis and counseling of affected patients.