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OPHTHALMIC IMAGE
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 865

Full thickness macular hole with “heart-urchin shell” artifact on en-face optical coherence tomography


Department of Vitreo Retina, Netralaya Superspeciality Eye Hospital, Ahmedabad, Gujarat, India

Date of Web Publication16-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
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_364_22

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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 Top

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.  Back to cited text no. 1
    
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.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    


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