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 Table of Contents  
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 281-282

"Teardrop on a hat" sign in a case of vitreomacular traction: Explaining the vector forces on optical coherence tomography imaging

1 Vitreo.Retina Consultant, Dr. Vaidya Eye Hospital, Mumbai, Maharashtra, India
2 Netram Eye Centre, Maharashtra, India

Date of Submission16-Apr-2021
Date of Acceptance28-Jul-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Harshit Vaidya
Dr Vaidya Eye Hospital, A-15, Doctor's Corner, Sitladevi Hsg Soc., Near DN Nagar, Metro Junction, Andheri Link Road, Andheri West, Mumbai - 400 058, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_830_21

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Keywords: Vitreo-macular traction, macular hole , outer retinal hole, foveal pseudocyst

How to cite this article:
Vaidya H, Suthar J. "Teardrop on a hat" sign in a case of vitreomacular traction: Explaining the vector forces on optical coherence tomography imaging. Indian J Ophthalmol Case Rep 2022;2:281-2

How to cite this URL:
Vaidya H, Suthar J. "Teardrop on a hat" sign in a case of vitreomacular traction: Explaining the vector forces on optical coherence tomography imaging. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 14];2:281-2. Available from: https://www.ijoreports.in/text.asp?2022/2/1/281/334981

A 59-year-old female complaining of diminution of vision in the left eye for 8 months with best-corrected vision of 20/30 and CF 1 m in the right and left eye, respectively, had nuclear sclerosis grade 1 in both eyes. Fundus examination of the right eye was unremarkable. The left eye revealed a clear vitreous cavity, a dull foveal reflex, while the rest of the retina was within normal limits. Optical coherence tomography of the right was normal. The left eye revealed vitreo-macular traction causing a foveal pseudocyst (tear drop) separated by a bridging retinal tissue and placed atop an outer macular hole with a splayed base (hat) and disrupted ellipsoid zone [Figure 1]a.
Figure 1: SD-OCT of the left eye. (a) Vitreo-macular traction (blue and red arrow – vertical and horizontal vector, respectively) causing a foveal pseudocyst (white arrow) – tear drop, atop an outer macular hole with a splayed base (yellow circle): Hat-sign. Ellipsoid layer defect (white star) (b) a and b dotted lines along the axis of the posterior hyaloid to the horizontal meridian. Angles α and β, < and >45°, respectively, to the horizontal meridian along the fovea represent the horizontal and vertical vectors causing the pull on the inner and outer retina, respectively

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  Discussion Top

Focal vitreomacular traction can either be U or V shaped. Tangential forces act in the horizontal and vertical direction, respectively. Horizontal traction tends to form pseudocysts in the inner retina by causing a split in the layers. Vertical or antero-posterior traction results in foveal detachment initially prior to formation of full-thickness macular hole (FTMH).[1],[2] Eyes with vertical traction tend to induce higher retinal tissue elevation along with broad-based impending macular hole, thereby leading to more severe destruction of retinal tissue and worse best-correct visual acuity as well as higher chances of conversion to FTMH as opposed to the horizontal traction group.[3] Posterior vitreous detachment and vitreomacular interface abnormalities are the most commonly associated conditions in cases with outer macular defects.[4] In the present case, we notice horizontal traction of the posterior hyaloid over the fovea nasally and vertical traction over the temporal aspect [Figure 1]b. The pull of the vertical vector appears to be greater than horizontal as evidenced by the vertically elongated pseudocyst and broad base of the outer hole. Ellipsoid layer defects at the base of the hole as well as temporally suggests probable chronicity or degenerative component and accounts for the severe loss of vision.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Theodossiadis G, Petrou P, Eleftheriadou M, Moustakas AL, Datseris I, Theodossiadis P. Focal vitreomacular traction: A prospective study of the evolution to macular hole: The mathematical approach. Eye (Lond) 2014;28:1452-60.  Back to cited text no. 1
Steel DH, Lotery AJ. Idiopathic vitreomacular traction and macular hole: A comprehensive review of pathophysiology, diagnosis, and treatment. Eye (Lond) 2013;27(Suppl 1):S1-21.  Back to cited text no. 2
Tsai CY, Hsieh YT, Lai TT, Yang CM. Idiopathic macular holes and direction of vitreomacular traction: Structural changes and surgical outcomes. Eye (Lond) 2017;12:1689-96.  Back to cited text no. 3
Cohen SY, Mrejen S, Nghiem-Buffet S, Dubois L, Fajnkuchen F, Gaudric A. Outer Foveal Microdefects. Ophthalmol Retina 2021;5:553-561.  Back to cited text no. 4


  [Figure 1]


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