This 23YO male presented with a recent loss of vision in his left eye. Vision was 20/60.
Optos color RG imaging shows a depigmented subretinal lesion in the superior fovea with overlying dots of blood and radiating retinal striae.
Fluorescein angiography shows a well-defined superior extrafoveal macular neovascularization (MNV). Swept-source B-scan OCT through this lesion shows a type 2 (above the RPE) MNV associated with shallow subretinal fluid and overlying radiating hyperreflective lines (pitchfork sign). These radiating lesions are uniquely visualized with en face OCT.
Intravitreal Avastin was begun.
Learning Points:
The pitchfork sign was originally described by Hoang et al (Retina 2013;33:1049-1055) as a unique OCT finding in inflammatory MNV. Falavarajani et al more recently noted that this finding is also associated with non-inflammatory MNV (Ophthalmic Surg Lasers Imaging Retina 2019;50:719-725).
The pathogenesis of the avascular pitchfork spikes is unknown, but may be related to outer retinal traction or Müller cell activation.
