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POSTENDOPHTHALMITIS "BUCKET HANDLE SIGN" SIGNIFIES BULLOUS INTERNAL LIMITING LAMINA SEPARATION.

Matthew G J Trese1, Viren Govindaraju1,2, Tedi Begaj1,2

  • 1Associated Retinal Consultants, Royal Oak, Michigan.

Retina (Philadelphia, Pa.)
|March 24, 2026
PubMed
Summary

The "Bucket Handle Sign" on optical coherence tomography (OCT) is a finding in patients with a history of endophthalmitis. This OCT sign represents bullous internal limiting lamina separation and is rarely visually significant.

Keywords:
bucket handle signendophthalmitisinternal limiting lamina separationspectral domain optical coherence tomography

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Retinal Diseases

Background:

  • Endophthalmitis is a severe intraocular inflammation.
  • Optical coherence tomography (OCT) is crucial for diagnosing intraocular conditions.
  • Post-inflammatory changes can alter retinal structures.

Purpose of the Study:

  • To describe a novel optical coherence tomography (OCT) finding termed the "Bucket Handle Sign" in patients with a history of endophthalmitis.
  • To characterize the features and prevalence of this sign.

Main Methods:

  • Retrospective chart review of patients with endophthalmitis (ICD-10 code H44.0X).
  • Analysis of optical coherence tomography (OCT) images to identify the "Bucket Handle Sign".
  • Histopathologic correlation of the OCT finding in one case.

Main Results:

  • The "Bucket Handle Sign" was identified in 8.2% (20/244) of patients with gradable OCTs after endophthalmitis.
  • Key OCT features include a thickened, hyper-reflective band with a convex shape.
  • Histology confirmed the sign represents post-endophthalmitis bullous internal limiting lamina separation.

Conclusions:

  • The "Bucket Handle Sign" is a notable OCT finding in a subset of patients with a history of endophthalmitis.
  • This sign is typically not visually significant and rarely requires surgical intervention.
  • Further research is needed to explore its pathogenesis and presence in other conditions.