Foveal crack sign and macular pattern dystrophy

TL;DR

This study investigates whether a foveal crack sign in macular pattern dystrophy leads to macular holes and its connection to hyperreflective foci.

Contribution

The study identifies a significant link between hyperreflective foci and the foveal crack sign in macular pattern dystrophy.

Findings

Only one eye with foveal crack sign developed a full-thickness macular hole.

Foveal crack sign was significantly more common in eyes with hyperreflective foci.

No significant difference in macular hole development between eyes with and without foveal crack sign.

Abstract

To determine if eyes with the foveal crack sign (FCS) in macular pattern dystrophy (MPD) progress to macular holes, and if FCS occurs in the context of hyperreflective foci (HRF) that do not reach the threshold of FCS.

: A retrospective chart review of eyes with MPD was conducted in the Atrium Health Wake Forest Baptist medical system. 56 eyes from 32 patients identified as having macular pattern dystrophy were identified. Demographic data were collected from charts and spectral domain optical coherence tomographs (SD-OCTs) were analyzed.

8 eyes from 6 patients were found to have an FCS-positive OCT at any point at or following their initial diagnosis of MPD. One eye developed a full-thickness stage 4 macular hole during follow-up. There was no significant difference in macular hole development between MPD eyes with and without FCS (p =.1429). There was a significant difference in FCS development between MPD eyes with and without HRF (p =.0063).

The data did not show a significant difference in macular hole generation between eyes with and without FCS, unlike the situation of FCS in eyes post vitrectomy for retinal detachment repair. The significant association between HRF and FCS suggests that the two signs may have a related pathophysiology and may represent different stages in a common degenerative process. Further work is needed to better characterize the relationship of FCS and HRF and to determine if FCS has different implications in the different clinical contexts in which it appears.

The online version contains supplementary material available at 10.1186/s40942-025-00655-8.

Figures