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Updated: Jun 16, 2026

In Vivo Multimodal Imaging and Analysis of Mouse Laser-Induced Choroidal Neovascularization Model
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In Vivo Multimodal Imaging and Analysis of Mouse Laser-Induced Choroidal Neovascularization Model

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Unfolding the Pitchfork Sign in Type 2 Choroidal Neovascularization: A Longitudinal Analysis and 3-Dimensional

Edoardo Balduzzi1,2, Giovanni Ometto3,4, Francesco Bandello1,2

  • 1Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Ophthalmology Science
|June 15, 2026
PubMed
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The pitchfork sign in type 2 choroidal neovascularization (CNV) involves outer retinal folding, not inflammation. Greater retinal deformation correlates with worse vision and higher post-treatment PED in CNV.

Area of Science:

  • Ophthalmology
  • Retinal Imaging
  • Neovascularization

Background:

  • Type 2 choroidal neovascularization (CNV) is a leading cause of vision loss.
  • The pitchfork sign is an OCT finding observed in type 2 CNV.
  • Its structural basis and clinical significance require further elucidation.

Purpose of the Study:

  • To longitudinally characterize the structural basis of the pitchfork sign in type 2 CNV.
  • To redefine its clinical significance using multimodal imaging.
  • To confirm its 3-dimensional structural configuration.

Main Methods:

  • Retrospective observational study of 39 eyes with treatment-naive type 2 CNV.
  • Spectral-domain OCT and 3D reconstructions were used to analyze outer retinal changes.
Keywords:
3D reconstructionEn face OCTOCTPitchfork signType 2 choroidal neovascularization

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  • Quantitative measures of retinal folds, fluid, and neovascularization were correlated with visual acuity.

    • Main Results:

    • The pitchfork sign represents mechanically induced outer retinal folding and splitting, not inflammation.
    • Fold number correlated with subretinal fluid and hyperreflective material height.
    • Greater fold height was associated with worse presenting visual acuity and higher post-treatment PED height.

    Conclusions:

    • The pitchfork sign is a transient, mechanical response of the outer retina to subretinal neovascularization.
    • Retinal deformation associated with the pitchfork sign predicts visual outcomes and treatment response in type 2 CNV.