|Year : 2022 | Volume
| Issue : 3 | Page : 693-694
Commentary: Intraretinal hyperreflective lines: A new optical coherence tomography finding or a biomarker?
Tanvi Soni1, Piyush Kohli2
1 Advanced Eye Center, Post-Graduate Medical Institute and Medical Research Institute, Chandigarh, India
2 Department of Vitreo Retinal Services, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
|Date of Web Publication||16-Jul-2022|
Dr. Piyush Kohli
Department of Vitreo Retinal Services, CL Gupta Eye Institute, Moradabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Soni T, Kohli P. Commentary: Intraretinal hyperreflective lines: A new optical coherence tomography finding or a biomarker?. Indian J Ophthalmol Case Rep 2022;2:693-4
|How to cite this URL:|
Soni T, Kohli P. Commentary: Intraretinal hyperreflective lines: A new optical coherence tomography finding or a biomarker?. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 11];2:693-4. Available from: https://www.ijoreports.in/text.asp?2022/2/3/693/351164
Owing to its excellent reproducibility, optical coherence tomography (OCT) has become the investigation of choice for diagnosing and monitoring the treatment of various macular disorders. Several OCT biomarkers have been identified for prognosticating patients with macular disorders such as diabetic retinopathy and age-related macular degeneration (ARMD). Biomarkers are the morphological and structural alterations that can potentially indicate the health status of the tissue, progression of the disease, and predict the visual prognosis of the patients. Intraretinal hyperreflective lines (IHLs) are one of the recently described OCT findings.
Chen et al. reported the presence of intraretinal hyperreflective foci in patients with acquired vitelliform macular lesions (AVL). They found that these foci appeared after the consolidation of the vitelliform lesions. The foci then started to migrate toward the inner retinal layers till they reached the outer plexiform layer/Henle fiber layer, after which they started to migrate laterally and eventually disappeared. These foci were demonstrated to originate from the retinal pigment epithelium (RPE) due to the presence of numerous lipofuscin and melanolipofuscin granules and melanosomes. These foci were not found to be significantly associated with the final visual acuity.
Scharf et al. identified vertical linear hyperreflective stress lines (extending from the internal limiting membrane, i.e., ILM to the ellipsoid zone) in the central fovea of eyes preceding the development of a full-thickness macular hole (FTMH), after successful MH surgery and concurrent with a lamellar macular hole (LMH). They proposed that these hyperreflective lines may be an indicator of the evolving vitreomacular traction (VMT) and a very early marker of the development of either a FTMH or an LMH.
Similarly, Amrosos et al. noted the presence of vertical IHLs in eyes with myopic subretinal hemorrhage, VMT, AVL, fundus flavimaculatus, and multiple evanescent white dot syndrome (MEWDS). They hypothesized that the IHLs in the case of MEWDS were caused by the inflammatory damage to the central cones and Müller cells, whereas the IHLs in VMT were secondary to the structural destabilization of the central cones and Müller cells. They showed that IHLs due to hemorrhagic or inflammatory pathologies were transient and regressed fully, IHLs in eyes with VMT regressed slowly, while IHLs associated with AVL or ARMD persisted without significant changes (except in cases when geographical atrophy or exudative ARMD developed). However, they could not establish any prognostic value associated with these lines.
We congratulate the authors for reporting the presence of vertical IHLs in a case of acute retinal pigment epithelitis (ARPE). ARPE or Krill's disease is a benign self-limiting disorder that was first described in 1974. It is characterized by the presence of a dome-shaped hyperreflective lesion in the outer neurosensory retina on OCT. It is caused by primary inflammation of the outer neurosensory retina, with the RPE being involved only in the secondary response., Although IHL has never been reported in association with this disorder, lesions similar to these lines have been noted. Puche et al. showed that the dense subretinal material in a case of ARPE resolved after 1 week while leaving hyperreflective dense vertical deposits at the border of the lesion, which also disappeared in another 2 weeks. Cho et al. reported the presence of expanded abnormal hyperreflectivity from the RPE to the outer nuclear layer (ONL) in a case of ARPE, which resolved along with the disruption of the ellipsoid zone. We agree with the authors that the IHLs probably appeared secondary to the changes in the reflectivity of the central cones and Muller cells, which were damaged by the acute inflammatory reaction. However, the prognostic value of these lines is still not understood. Further large sample prospective studies are required to evaluate this association.
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