Morphological patterns of indirect choroidal rupture on spectral domain optical coherence tomography

Posterior Retinal Breaks Secondary to Closed-Globe Blunt Ocular Trauma

Purpose: To describe 2 cases of posterior pole retinal tears resulting from closed-globe trauma. Methods: Two cases of retinal breaks in the posterior pole after blunt ocular trauma were evaluated, and the relevant literature was reviewed. Results: Two eyes of 2 patients with posterior pole retinal tears secondary to closed-globe trauma were included. One patient had a pars plana vitrectomy with laser retinopexy and gas tamponade; the final Snellen visual acuity (VA) was 20/200. The second patient was treated with indirect laser retinopexy; the final Snellen VA was counting fingers. Conclusions: The rapid deformation of the globe in response to blunt ocular trauma may create significant tangential stress on the retina, leading to stretch breaks in the posterior pole. Clinicians should follow patients with a closed-globe injury to watch for retinal breaks in the posterior pole, in particular when a hemorrhage or other pathology obscures the view.

A reappraisal of indirect choroidal rupture using swept-source optical coherence tomography in-vivo pathology images in patients with blunt eye trauma

Purpose

To describe the in-vivo pathology of indirect choroidal rupture (ICR) in patients with recent ocular trauma using swept-source optical coherence tomography (SSOCT).

Methods

Retrospective observational study of the presenting and follow-up OCT images of four consecutive Asian patients with blunt trauma presenting over a period of 6 months and review of OCT descriptions in the literature.

Results

The three patients who presented within 2 weeks of injury showed a gap in the Bruch's membrane (BM)/retinal pigment epithelial complex at the site of the ICR. The distance of the gap ranged from 103 to 465 μm. Blood from associated tear in the choriocapillary layer dissected under the photoreceptor layer to lift it off the retinal pigment epithelium (RPE) layer. The Sattler's and Haller's layers of the choroid were not affected. Fibro-vascular proliferation occurring in the reparative phase bridges the gap in the BM, RPE complex. Late fibrous tissue proliferation extends into the Sattler's layer in the choroid and goes up to the outer nuclear layer in the retina disrupting its architecture.

Conclusion

SSOCT is a useful tool to study the pathology of recent onset ICR as it is capable of imaging through blood. The primary injury in ICR seems to be a break in the Bruch's membrane. The RPE layer and choriocapillaries get disrupted secondary to the break in the BM as their basement membranes are part of the BM. Scarring during the reparative phase disrupts the adjacent layers of the choroid and retina.

Focal choroidal excavation: review of literature

Focal choroidal excavation (FCE) is defined as an area of concavity in choroid detected on optical coherence tomography. These are mostly present in macular region without evidence of accompanying scleral ectasia or posterior staphyloma. Though initially considered to be congenital, increasing number of cases have been identified in association with other choroidal pathologies such as central serous choroidopathy, choroidal neovascularisation, polypoidal choroidal vasculopathy, choroiditis, choroidal tumours. In this review article, we aim to elaborate on the morphology, pathogenesis and differential diagnosis of FCE and specifically discuss the spectrum of diseases with known association along with the impact of their treatment on FCE

Predictors for choroidal neovascular membrane formation and visual outcome following blunt ocular trauma

Aim:

The aim of this study was to determine the predictors for choroidal neovascular membrane formation and visual outcome after blunt ocular trauma.

Methods:

Retrospective review of electronic medical records of patients with blunt ocular trauma from January 2013 to December 2016 at Narayana Nethralaya Super Speciality Eye Hospital (Bangalore, India) was done. Cases with positive macular findings were enrolled. Data such as age, sex, laterality, mode of injury, presenting and final vision, follow-up duration and retinal findings were noted.

Results:

A total of 853 cases were referred to the retina clinic with history of blunt ocular trauma. Of which, 37 cases with positive macular findings were identified. Trauma with ball (18/37, 49%) was the most common mode of injury. Choroidal rupture was seen in 33 (89%) eyes. Other retinal findings noted were as follows: retinal haemorrhages (11%), commotio retinae (22%), submacular haemorrhage (43%), macular hole (11%), epiretinal membrane (3%), macular scar (8%) and vitreous haemorrhage (4%). Choroidal neovascular membrane was noted in 6 (16%) out of 37 eyes. No retinal findings showed any positive association with choroidal neovascular membrane formation. Using Pearson’s correlation test, independent variables such as presenting visual acuity (r = 0.601, p = 0.000) and choroidal neovascular membrane formation (r = –0.356, p = 0.031) showed a strong correlation with final visual acuity.

Conclusion:

The occurrence rate of post-traumatic choroidal neovascular membranes is about 12% in eyes with choroidal rupture. Most choroidal neovascular membranes occur within 1 year of trauma. Eyes with poor presenting vision and choroidal rupture or subretinal haemorrhage warrant regular and shorter follow-up intervals for long periods to identify the choroidal neovascular membrane. Treatment with intravitreal anti-vascular endothelial growth factor therapy is useful.