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

To describe an optical coherence tomography finding termed the "Bucket Handle Sign" in patients with a history of endophthalmitis.

The electronic heath record from a single institution was queried for the international classification of disease 9/10 codes (H44.0X) corresponding to endophthalmitis from January 1, 2013 to December 31, 2022. Identified patients were cross-referenced with optical coherence tomographies to quantify patients with bucket handles. Histopathologic analysis of the corresponding tissue was performed on one eye that underwent vitrectomy.

A total of 854 patients were diagnosed with endophthalmitis. Of these, 244 had gradable optical coherence tomographies, and 20 (8.2%) demonstrated a bucket handle sign. Key features of the bucket handle sign include a thickened hyper-reflective band separated from the underlying retina, a convex shape and a rounded angle of contact. Histologic analysis demonstrated that this optical coherence tomography finding was postendophthalmitis bullous internal limiting lamina separation.

The bucket handle sign was seen in a significant minority of patients with a history of endophthalmitis. Its presence was rarely visually significant and warranted surgical intervention in select cases. Further research is required to understand the mechanism and to identify other pathologies where the bucket handle sign may be observed.