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 Table of Contents  
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 693-694

Commentary: Intraretinal hyperreflective lines: A new optical coherence tomography finding or a biomarker?

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 Publication16-Jul-2022

Correspondence Address:
Dr. Piyush Kohli
Department of Vitreo Retinal Services, CL Gupta Eye Institute, Moradabad, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_3012_21

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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 2023 Jun 9];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.[1] 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.[2] Intraretinal hyperreflective lines (IHLs) are one of the recently described OCT findings.[3]

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.[4]

Scharf et al.[5] 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.[3] 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).[6] 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.[7],[8] Although IHL has never been reported in association with this disorder, lesions similar to these lines have been noted. Puche et al.[8] 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.[7] 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.

  References Top

Bhende M, Shetty S, Parthasarathy MK, Ramya S. Optical coherence tomography: A guide to interpretation of common macular diseases. Indian J Ophthalmol 2018;66:20-35.  Back to cited text no. 1
[PUBMED]  [Full text]  
Phadikar P, Saxena S, Ruia S, Lai TYY, Meyer CH, Eliott D. The potential of spectral domain optical coherence tomography imaging based retinal biomarkers. Int J Retina Vitreous 2017;3:1-10.  Back to cited text no. 2
Amoroso F, Mrejen S, Pedinielli A, Tabary S, Souied EH, Gaudric A, et al. Intraretinal hyperreflective lines. Retina 2021;41:82-92.  Back to cited text no. 3
Chen KC, Jung JJ, Curcio CA, Balaratnasingam C, Gallego-Pinazo R, Dolz-Marco R, et al. Intraretinal hyperreflective foci in acquired vitelliform lesions of the macula: Clinical and histologic study. Am J Ophthalmol 2016;164:89-98.  Back to cited text no. 4
Scharf JM, Hilely A, Preti RC, Grondin C, Chehaibou I, Greaves G, et al. Hyperreflective stress lines and macular holes. Invest Ophthalmol Vis Sci 2020;61:50. doi: 10.1167/iovs. 61.4.50.  Back to cited text no. 5
Singh A, Beg H, Gaur R, Kothari A, Chugh M, et al. Intraretinal hyperreflective line in association with acute retinal pigment epithelitis. Indian J Ophthalmol Case Rep 2022;3:691-3.  Back to cited text no. 6
Cho HJ, Han SY, Cho SW, Lee DW, Lee TG, Kim CG, et al. Acute retinal pigment epitheliitis: Spectral-domain optical coherence tomography findings in 18 cases. Invest Ophthalmol Vis Sci 2014;55:3314-9.  Back to cited text no. 7
Puche N, Offret O, Bernard JA, Behar-Cohen F. A case of acute retinal pigment epithelitis: Spectral domain optical coherence tomography time course and physiopathologic hypothesis. Clin Ophthalmol 2010;4:1029-33.  Back to cited text no. 8


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