Purpose: During perfused retinal vein occlusions, patchy retinal opacification due to acute neuronal swelling may be present. This may be difficult to document using conventional imaging techniques.
Methods: Three-dimensional topography of focal retinal opacification was documented in a patient with hemiretinal vein occlusion by combining en face adaptive optics (AO) imaging with high-resolution optical coherence tomography (OCT).
Results: Patchy retinal opacification in the macula was faintly visible by color fundus photography with no angiographic correlation. Adaptive optics and OCT imaging showed that these areas were located in the plexiform layers while the nerve fiber layer remained spared. During follow-up, visual acuity returned to 20/20 with normalization of fundus features and of AO imaging. At last examination, optical coherence tomography showed thinning of the inner nuclear layer in the area previously opacified.
Conclusions: Patchy retinal opacification that may be observed at the acute phase of perfused central retinal vein occlusion corresponds to ischemic opacification of intermediary neurons within the inner nuclear and inner plexiform layers.