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Introduction
Choroidal neovascularization (CNV) may be classified according to the spectral-domain optical coherence tomography (OCT) location of the proliferating vessels.1 Type 1 CNV is identified under the retinal pigment epithelium (RPE), whereas type 2 CNV is noted above the RPE in the subretinal space.2 Type 3 CNV is intraretinal and originates from the deep retinal capillary plexus.3–5
Type 2 CNV is an infrequent complication of exudative age-related macular degeneration (AMD) more likely to develop in younger patients with myopia or multifocal choroiditis.6 This has been attributed to a more adherent basement membrane of the retinal pigment epithelium (RPE) in younger patients.2 Clinically these lesions may display a subretinal pigmented halo around the neovascular lesion.7 With OCT, a band of subretinal hyperreflective material (SHRM) may be noted in the subretinal space.1 However, other OCT features have also been described.8,9 Hoang et al.9 reported the “pitchfork sign” as a distinct finding of type 2 CNV specifically in eyes with inflammatory related multifocal choroiditis.
En face structural OCT imaging is acquired through reconstruction of the high-density, three-dimensional raster scans and provides depth-resolved visualization of the various retinal and/or choroidal slabs presented in the coronal plane. Several studies have demonstrated the benefit of en face OCT imaging in the evaluation of retinal and choroidal disorders.10,11 The aim of this study was to describe a new en face OCT imaging feature of type 2 CNV and illustrate the OCT angiography (OCTA) findings in these eyes before and after anti-vascular endothelial growth factor (VEGF) therapy. This paper will broaden the scope of disease associated with the pitchfork sign and improve our understanding of this finding and provide explanations for its development on the basis of the novel en face features presented.
Patients and Methods
Institutional review board approval was obtained from the respective coauthor institutions and the study adhered to the principles of the Declaration of Helsinki. Informed consents were obtained.
Inclusion criteria for the study included patients with new onset active choroidal neovascularization as determined by clinical examination and multimodal retinal imaging. All patients required high-quality baseline spectral-domain B-scan OCT, as well as en face OCT and OCTA imaging, to be included in the study. Eyes with type 2 neovascularization and the “pitchfork sign” as identified with cross sectional B...