Acute Precursor of Retinal Ischemic Perivascular Lesion Identified on Optical Coherence Tomography B-Scans in Two Patients with Different Etiologies.

PURPOSE: To demonstrate optical coherence tomography (OCT) imaging findings of the acute hyperreflective retinal injury preceding retinal ischemic perivascular lesion (RIPL) formation in two patients with differing etiologies.

METHODS

Retrospective chart review of two patients with RIPLs and regular macular OCT imaging through their clinical course from initial presentation through treatment and follow-up.

RESULTS

Four eyes of two patients who presented with focal acute hyperreflectivity in the middle retina that developed into a RIPL. The two patients had different underlying pathologies: one with a branch retinal artery occlusion with a history of atrial fibrillation and hypertension and the other with Purtscher's retinopathy and cytomegalovirus retinitis. RIPL formation was consistent, involving middle retina hyperreflectivity developing into inner nuclear layer thinning, outer plexiform layer displacement, and outer nuclear layer expansion.

CONCLUSION

Similar to other microvascular events in the retinal ischemic cascade, RIPL formation is preceded by a focal hyperreflective lesion. Furthermore, RIPLs are a subclinical consequence of microvascular injury but are not disease specific.