Foveal Crack Sign: An OCT Sign Preceding Macular Hole After Vitrectomy for Rhegmatogenous Retinal Detachment

Area of Science:

• Ophthalmology
• Retinal Surgery
• Medical Imaging

Background:

• Pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) can lead to secondary macular hole (MH) formation.
• Identifying predictive signs of MH development is crucial for improving surgical outcomes.

Purpose of the Study:

• To describe a specific optical coherence tomography (OCT) sign that precedes MH formation after PPV for RRD.
• To evaluate the predictive value of this OCT sign for secondary MH development.

Main Methods:

• Retrospective observational case series of patients undergoing PPV for RRD.
• Sequential OCT imaging analysis was performed to identify characteristic signs before MH formation.
• Medical records were reviewed to correlate OCT findings with clinical outcomes.

Main Results:

• A parafoveal epiretinal membrane (ERM) and a foveal crack sign (FCS) were consistently observed before secondary MH formation.
• The FCS, characterized as a hyperreflective vertical line in the foveola, appeared a median of 255 days before MH development.
• In a larger cohort, the FCS with parafoveal ERM was identified in 3 eyes without subsequent MH formation.

Conclusions:

• The foveal crack sign (FCS) in conjunction with parafoveal epiretinal membrane (ERM) is a potential predictor of secondary macular hole formation after PPV for RRD.
• This OCT finding suggests that ERM traction plays a significant role in the pathogenesis of secondary MHs.