For patients who undergo vitrectomy for a retinal detachment, a foveal hyperreflective vertical line revealed on optical coherence tomography (OCT) may be a telltale sign that a second macular hole is forthcoming, a research team from Japan suggests.

Their study, published in the American Journal of Ophthalmology, included patients who underwent vitrectomy for retinal detachment between 2014 and 2017. The investigators evaluated the medical records of 10 patients who had a secondary macular hole after retinal detachment repair and the sequential changes as seen on OCT imaging and compared them with those of 518 eyes that also had the procedure.

Before the macular hole formed, all 10 eyes had a hyperreflective vertical line in the foveola and a deformation of the fovea, which was defined as a “foveal crack sign,” accompanied by a parafoveal epiretinal membrane. The foveal crack sign was discovered at about 255 days after the vitrectomy procedure, and the macular hole developed at approximately 232 days after the foveal crack appeared.

Among the 518 eyes that underwent the same surgery, this unique finding was found in three eyes without a succeeding macular hole after retinal repair about a year following the procedure.

As a result of these findings, the researchers suggest eyes with a foveal crack sign following retinal detachment repair need a careful follow-up.

Ishibashi T, Iwama Y, Nakashima H, et al. Foveal crack sign: an optical coherence tomography sign preceding macular hole after vitrectomy for rhegmatogenous retinal detachment. Am J Ophthalmol. May 29, 2020. [Epub ahead of print].