ANGULAR SIGN OF HENLE FIBER LAYER HYPERREFLECTIVITY IN CONTUSION MACULOPATHY: A Multimodal Imaging Analysis

To describe the multimodal imaging findings of the angular sign of Henle fiber layer hyperreflectivity at baseline and follow-up in patients with contusion maculopathy.

Eleven eyes of 10 patients were captured with multimodal imaging after nonpenetrating ocular blunt trauma from a soccer ball, fist, or airsoft pellet. Baseline clinical and imaging characteristics and follow-up outcomes are presented.

Hyperreflective lesions extending along the Henle fiber layer from the ellipsoid zone to the outer plexiform layer consistent with angular sign of Henle fiber layer hyperreflectivity were identified with optical coherence tomography. The mean presenting visual acuity was logMAR 0.59 ± 0.64 (Snellen visual acuity 20/77, range 20/25 to counting fingers) and the follow-up visual acuity was logMAR 0.43 ± 0.35 (Snellen visual acuity 20/53, range 20/20-20/200). Additional optical coherence tomography findings included external limiting membrane attenuation and retinal pigment epithelium disruption. On follow-up, resolution of angular sign of Henle fiber layer hyperreflectivity was accompanied by outer nuclear layer thinning with varying degrees of ellipsoid zone attenuation and retinal pigment epithelium loss. A macular hole was detected in one patient on follow-up.

Angular sign of Henle fiber layer hyperreflectivity is a distinctive acute optical coherence tomography feature of contusion maculopathy secondary to blunt injury, causing disruption of the photoreceptors and presumably anterograde alterations in the Henle fiber layer. Associated retinal pigment epithelium alterations may ensue, either acutely or delayed, and are a biomarker of persistent structural abnormalities and variable visual outcomes.