Hyperreflective Stress Lines and Macular Holes

Abstract

To determine the prevalence of a central hyperreflective line in eyes with fullthickness macular holes (FTMH) and lamellar macular holes (LMH) and to elucidate the pathoanatomic importance of this optical coherence tomography (OCT) sign. METHODS. This retrospective analysis evaluated patients with FTMH and LMH at the Stein Eye Institute. Clinical data was collected and SD-OCT volume scans were analyzed for the presence of a central vertical hyperreflective line in 3 separate cohorts: patients with SD-OCT preceding FTMH development, patients with SD-OCT after pars plana vitrectomy (PPVT) treatment for FTMH, and patients with SD-OCT of LMH. RESULTS. In total, 93 eyes with FTMH and 88 eyes with LMH were identified. Of the 93 FTMH eyes, SD-OCT volume scans were available before development of the FTMH in 12 eyes. Of these, 6 (50%) displayed a vertical hyperreflective line preceding the development of the FTMH. Fifty-one eyes underwent PPVT with resolution of the FTMH, and 26 displayed a hyperreflective line after resolution (51%). Of the 88 eyes with LMH, 22 displayed a hyperreflective line (25%). All hyperreflective lines were noted at the central fovea. CONCLUSIONS. SD-OCT illustrated the presence of a central vertical hyperreflective line preceding FTMH and after resolution of FTMH after PPVT in approximately one-half of cases, and concurrent with LMH in 25% of cases. This vertical hyperreflective line may represent an early SD-OCT marker for the development of FTMH, and may be a sign of central foveal dehiscence owing to disruption of the Muller cell cone.

Foveal crack sign as a predictive biomarker for development of macular hole in fellow eyes of patients with full-thickness macular holes

“…In the present study, we analyzed SD-OCT images of fellow eyes of patients with FTMH. In our cohort of patients, the novel previously described 8,9 OCT finding termed "foveal crack sign" could be seen in 19 of 113 cases (17%). 10 (53%) of these 19 eyes developed a FTMH during the observation period.…”

“…In a recent work of Ishibashi et al FCS was shown to precede macular hole formation after vitrectomy in 10 eyes of 10 patients 8 . Scharf et al showed in a recent study, that 50% of the eyes with FTMH displayed the foveal crack sign preceding macular hole formation 9 . In our study, 10 (83%) of 12 cases of FTMH development demonstrated FCS prior to FTMH formation.…”

“…Ishibashi et al described a novel optical coherence tomography sign—foveal crack sign—which preceded macular hole formation after vitrectomy for rhegmatogenous retinal detachment in all 10 cases 8 . Another recent study of Scharf et al observed the presence of a central hyperreflective line in the fovea on spectral-domain optical coherence tomography (SD-OCT) preceding FTMH and after resolution of FTMH after vitrectomy in approximately half of the cases 9 . They concluded that this hyperreflective line seen on SD-OCT images might represent an early diagnostic marker for FTMH development.…”

“…et al observed the presence of a central hyperreflective line in the fovea on spectral-domain optical coherence tomography (SD-OCT) preceding FTMH and after resolution of FTMH after vitrectomy in approximately half of the cases 9 . They concluded that this hyperreflective line seen on SD-OCT images might represent an early diagnostic marker for FTMH development.…”

Detailed analyses of microstructure of photoreceptor layer at different severities of occult macular dystrophy by ultrahigh-resolution SD-OCT

“… 23 , 24 We suggest that abnormal phagocytosis of the outer segments during the disease process produced the cluster of rotated packets of outer segment disks which had abnormal hyperreflectivity in the outer segment region. The HRDs may also be attributed to the increased reflectivity of the outer segments alone due to mechanical stress 25 or degenerative changes. 26 …”