This 49YO male presented with acute vision loss of 20/400 in his right eye from an idiopathic macular neovascularization (MNV).
Color photography shows shallow foveal fluid with some areas of subretinal blood. Swept-source OCT shows outer macular edema, shallow subretinal fluid, and radiating hyperreflective lines (pitchfork sign). These radiating lesions are uniquely visualized with en face OCT.
The lesion was virtually dry, with resolution of the pitchfork lesion 1 month after a single intravitreal Avastin injection. Vision improved to 20/80.
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.
