To clarify the pathophysiology of linear hypofluorescent lesions observed by fluorescein angiography (FA) in the posterior fundus of eyes with pathologic myopia and to compare the features of these lesions with those of lacquer cracks.
Medical records of 117 eyes of 81 highly myopic patients, which had linear lesions with abnormal fluorescence by FA were reviewed. Features obtained by fundus autofluorescence, indocyanine green angiography, and optical coherence tomography were also analyzed.
In 37 of 117 eyes, the linear lesions were hyperfluorescent in the fluorescein angiograms and appeared yellowish ophthalmoscopically. Optical coherence tomography showed discontinuities of retinal pigment epithelium; thus, they were considered to represent lacquer cracks. In the remaining 80 eyes, the linear lesions were hypofluorescent by FA and ophthalmoscopic observation showed pigmented brown lines. Optical coherence tomography showed clumps of retinal pigment epithelium at the corresponding sites. Although indocyanine green angiography showed hypofluorescence in both types of lesions, fundus autofluorescence showed hyperautofluorescence of hypofluorescent lines by FA and hypoautofluorescence of lacquer cracks. Hypofluorescent lines by FA were considered to be the same as myopic stretch lines.
There are two types of linear lesions in the posterior fundus of highly myopic eyes; lacquer cracks and myopic stretch lines, and they should be differentiated.