Foveal hyper-reflective vertical lines detected by optical coherence tomography: Imaging features, literature review and differential diagnoses

Purpose: To describe foveal hyper-reflective vertical lines (FVL) as a specific morphological finding on structural spectral-domain optical coherence tomography (SD-OCT) and discuss its differential diagnosis. Methods: Observational case series. Ten patients (10 eyes) with FVL were meticulously examined at the Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel. Detailed analysis of SD-OCT findings, clinical records, and retinal imaging was conducted to establish correlations between FVL and various underlying conditions. Results: We established the following list of settings, supported by the clinical context and ancillary investigations, in which SD-OCT displayed FVL: inflammation (1 eye), mechanical (1 eye), resorption of fluids of various origins (4 eyes), macular telangiectasia (1 eye), age-related macular degeneration (1 eye), diabetic retinopathy (1 eye) and scar (1 eye). Conclusions: FVL can be observed in various underlying conditions. Recognition of this pattern and formulation of an appropriate differential diagnosis is of interest for correctly diagnosing and treating patients whose structural OCT harbors this yet overlooked finding.