The pitchfork sign (PS) is a distinctive finding on optical coherence tomography (OCT) that is characteristic of type 2 macular neovascularization (MNV) secondary to punctate inner choroidopathy (PIC)^(1-3). A 57-year-old male presented to us with complaints of blurring of vision in the right eye (OD) for one month. At the time of admission, the best-corrected visual acuity was 20/150. OCT and OCT angiography revealed a PS (Figure 1). Thus, the patient was diagnosed with type 2 MNV secondary to PIC. A loading dose of three aflibercept intravitreal injections (IVI) was administered. No other drugs were prescribed. A good response was observed in the treated eye. At the 1-year follow-up, no neovascularization reactivity was observed, and the visual acuity had improved to 20/20 (Figure 2). The first-choice treatment for MNV is anti-VEGF IVIs. Other reports have described good morphofunctional results in patients treated with bevacizumab or ranibizumab. However, they reported the reappearance of new lesions^(2,4). In our patient, the visual acuity significantly improved and the retinal lesions regressed after the administration aflibercept IVIs, without the use of corticosteroids or immunosuppressants.

AUTHORS' CONTRIBUTIONS:

Significant contribution to conception and design - Isabela Spinelli Mota, Juliana Souza Gomes, Maria Fernanda Cunha, Michelle Gantois. Data acquisition: Isabela Spinelli Mota, Juliana Souza Gomes, Maria Fernanda Cunha, Michelle Gantois. Data analysis on interpretation: Isabela Spinelli Mota, Juliana Souza Gomes, Maria Fernanda Cunha, Michelle Gantois. Manuscript drafting: Isabela Spinelli Mota, Juliana Souza Gomes, Michelle Gantois. Significant intellectual content revision of the manuscript: Isabela Spinelli Mota, Juliana Souza Gomes, Maria Fernanda Cunha, Michelle Gantois. Final approve of the manuscript: Isabela Spinelli Mota, Juliana Souza Gomes, Maria Fernanda Cunha, Michelle Gantois. Statistical analysis: Not applicable. Obtaining funding: Not applicable. Supervision of administrative, technical, or material support: Michelle Gantois. Research group leader: Michelle Gantois.

REFERENCES

1. Watzke RC, Packer AJ, Folk JC, Benson WE, Burgess D, Ober RR. Punctate inner choroidopathy. Am J Ophthalmol.1984;98(5):572-84.

2. Ahnood D, Madhusudhan S, Tsaloumas MD, Waheed NK, Keane PA, Denniston AK. Punctate inner choroidopathy: A review. Surv Ophthalmol. 2017;62(2):113-26.

3. Hoang QV, Cunningham ET Jr, Sorenson JA, Freund KB. The “pitchfork sign” a distinctive optical coherence tomography finding in inflammatory choroidal neovascularization. Retina. 2013;33(5):1049-55.

4. Lupidi M, Muzi A, Castellucci G, Kalra G, Piccolino FC, Chhablani J, et al. The choroidal rupture: Current concepts and insights. Surv Ophthalmol. 2021;66(5):761-70.

Submitted for publication: May 24, 2024.
Accepted for publication: July 26, 2024.

Funding: This study received no specific financial support.

Disclosure of potential conflicts of interest: The authors declare no potential conflicts of interest.