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| OPHTHALMIC IMAGE |
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| Year : 2022 | Volume
: 2
| Issue : 3 | Page : 865 |
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Full thickness macular hole with “heart-urchin shell” artifact on en-face optical coherence tomography
Kushal Delhiwala, Rushik Patel, Bakulesh Khamar
Department of Vitreo Retina, Netralaya Superspeciality Eye Hospital, Ahmedabad, Gujarat, India
| Date of Web Publication | 16-Jul-2022 |
Correspondence Address:
Dr. Kushal Delhiwala
Netralaya Superspeciality Eye Hospital, KD House, 1st Floor, Above Union Bank of India, Parimal Cross Roads, Ellisbridge, Ahmedabad - 380 006, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_364_22
How to cite this article:
Delhiwala K, Patel R, Khamar B. Full thickness macular hole with “heart-urchin shell” artifact on en-face optical coherence tomography. Indian J Ophthalmol Case Rep 2022;2:865 |
How to cite this URL:
Delhiwala K, Patel R, Khamar B. Full thickness macular hole with “heart-urchin shell” artifact on en-face optical coherence tomography. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 11];2:865. Available from: https://www.ijoreports.in/text.asp?2022/2/3/865/351182 |
A 59-year-old phakic female with a left eye full-thickness macular hole (FTMH) had a visual acuity of 20/200. The swept-source optical coherence tomography (SSOCT) B-scan showed FTMH, stage-3 posterior vitreous detachment,[1] operculum, and para-foveal cystoid changes [Figure 1]a. Structural en-face SSOCT corresponding to SSOCT angiography (SSOCTA) of FTMH at the deep-vascular-plexus layer revealed a hyper-reflective center and hypo-reflective spaces parafoveally [Figure 1]b. These represent image artifacts seen on SSOCTA of FTMH because of erroneous segmentation of deep-vascular-plexus layer passing (1) below the retinal pigment epithelium (RPE) centrally leading to increased light transmission, thereby causing hyper-reflectivity, and (2) through para-foveal cystoid spaces in inner nuclear and outer plexiform layers causing hypo-reflectivity.[2],[3] The artifact in the index case resembled scanning-electron-microscopic appearance of a “heart-urchin shell” ossicle.[4] Such artifacts are also reported to have “jellyfish-like” appearance.[2] These artifacts are amenable to manual correction using in-built machine software [Figure 1]c.[2] | Figure 1: (a) SSOCT B-scan of left eye FTMH. (b) Structural en-face SSOCT corresponding to SSOCTA of FTMH at the deep-vascular plexus showing a hyper-reflective center and para-foveal hypo-reflective spaces, resembling the scanning electron microscopy image of a “heart urchin shell” ossicle. These central and para-foveal findings are artifacts resulting from erroneous layer segmentation (white arrow) below RPE and through cystoid spaces in the inner nuclear and outer plexiform layers, respectively. (c) Image of (b) after manual segmentation correction using in-built machine software (white arrow)
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Hayashi K, Sato T, Manabe SI, Hirata A. Sex-related differences in the progression of posterior vitreous detachment with age. Ophthalmol Retina 2019;3:237-43.  |
| 2. | Michalewska Z, Nawrocki J. Swept-source OCT angiography of full-thickness macular holes: Appearance and artifacts. Ophthalmic Surg Lasers Imaging Retina 2018;49:111-21. |
| 3. | Rizzo S, Savastano A, Bacherini D, Savastano MC. Vascular features of full-thickness macular hole by OCT angiography. Ophthalmic Surg Lasers Imaging Retina 2017;48:62-8. |
| 4. | Müter D, Sørensen HO, Oddershede J, Dalby KN, Stipp SLS. Microstructure and micromechanics of the heart urchin test from X-ray tomography. Acta Biomater 2015;23:21-6. |
[Figure 1]
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