Abstract: Objective To observe the imaging features of optical coherence tomography(OCT)in patients with incipient monocular black shadow flutter. Methods This study was a prospective case series. 113 cases(113 eyes)with complaints of monocular dark shadow flutter within 1 week were included in this study. All affected eyes underwent visual acuity, intraocular pressure, slit lamp microscopy, indirect fundoscopy with dilated pupil, super wide angle scanning laser fundoscopy(SLO), and OCT at baseline and 6 weeks later. image acquisition for SLO and OCT was performed before dilating the pupil. Results The proportion of retinal tears in the vitreous cavity with punctate hyperreflectivity was 29.2% and 2.2% in the positive and negative groups, respectively(χ2=21.856, P<0.001). The preretinalstriated hemorrhages of the peripheral cavity were 29.2% and 1.1%(χ2=26.139, P<0.001)in the vitreous cavity punctate hyperreflective positive and negative groups, respectively. In infrared spectroscopy(IR)of OCT, retinal fissures were 38.5% and 4%(χ2=18.856, P<0.001)in the positive and negative groups of multiple pre-retinal occluding shadows. 4%(χ2=18.639, P<0.001). Peripheral pre-retinal strip hemorrhages were more prevalent in the multiple pre-retinal masking shadow positive group than in the negative group, and the difference was statistically significant in all cases(χ2=48.839, P<0.001). Conclusion The observation of punctate hyperreflectivity of the vitreous cavity in OCT and the presence of multiple pre-retinal masking shadows on IR maps in patients with initial monocular black shadow flutter need to be considered for retinal tears or pre-retinal hemorrhages.

Key words: Vitreous cavity hyper reflection, Optical coherence tomography, Retinal tears, Floaters, Retina detachment