The Pigtail Sign: A New Spectral Domain Optical Coherence Tomography Finding After Inverted ILM Flap Surgery for Idiopathic Macular Hole

Clin Ophthalmol. 2020 Sep 3:14:2577-2581. doi: 10.2147/OPTH.S271703. eCollection 2020.


Purpose: To report a new spectral domain optical coherence tomography (OCT) finding called the pigtail sign. It was found during follow-up of idiopathic macular hole cases after inverted internal limiting membrane (ILM) flap surgery.

Methods: This is a retrospective case series of 12 eyes (12 patients) who underwent inverted ILM flap technique for idiopathic macular hole closure. Spectral domain optical coherence tomography images were analyzed for the presence of this new finding.

Results: A new spectral domain OCT finding of a curved coiled line hanging above the surface of the retinal layers was seen in all patients. The mean preoperative best corrected visual acuity (BCVA) logMAR value was 1.25 ± 0.11. At the 6-month follow-up visit, the mean LogMAR BCVA was 0.35 ± 0.18. All the cases showed macular hole closure after surgery.

Conclusion: This new spectral domain OCT sign can be seen in some OCT scans during follow-up of idiopathic macular hole cases after inverted ILM flap surgery.

Keywords: inverted ILM flap; macular hole; pigtail sign.