A Case of Expansion of Traumatic Choroidal Rupture with Delayed-Developed Outer Retinal Changes

Abstract

Background: This study aims to report the expansion of a choroidal rupture site caused by blunt ocular trauma using scanning laser ophthalmoscope-optical coherence tomography. Case Report: The clinical course of a 15-year-old girl with a traumatic ocular injury after being hit in the eye by an elbow was evaluated. Upon the first examination, the best-corrected visual acuity was 16/20. The findings were subretinal pigment epithelial hemorrhage and vertical choroidal rupture. Three weeks after the trauma, the patient's visual acuity was reduced to counting fingers at 30 cm. On fundus examination and fluorescein angiography subretinal pigment epithelial hemorrhage decreased, while the choroidal rupture expanded; on optical coherence tomography outer retinal changes in the adjacent area were detected. Discussion: This study reveals that the delayed expansion of a choroidal rupture site and the delayed change of the adjacent outer retina improved.

En-Face Optical Coherence Tomography Imaging in a Case of Choroidal Rupture

“…6 Furthermore, it would be hard to decide the appropriate line for the OCT B-scan examination when the typical fundus findings were unclear. 1,3,7,8 When compared with the findings on en-face OCT images, we observed the OCT B-scan images at the exact location of the lesions. Therefore, when assessing fine lesions by OCT B-scan images, a comparison with en-face OCT images seems useful.…”

“…In a case of a choroidal rupture, secondary choroidal neovascularization that occurred at a relatively early stage was reported. 7 Therefore, frequent follow-up evaluations are optimal. In the current case, we easily followed the morphologic changes associated with the choroidal rupture using en-face OCT imaging.…”

Severe blunt eye trauma causes a decrease in central macular thickness within first 48 hours of trauma

“…This finding is interesting because we expected the development of macular edema. Patients with mild cases of commotio retina present transient visual loss and recover spontaneously, but more severe cases may be associated with permanent visual loss [10,15]. The decrease in CMT in severe cases may be associated with the cellular loss and may be associated with a worse prognosis that should be studied further.…”

“…It may be restricted to the macula or involve areas of the peripheral retina [13]. Previously, macular findings after trauma were described as ranging from mild pallor to macular hole formation [14,15]. Based on histopathological findings from the eyes of human cadavers, investigators showed that the major site of injury in commotio retinae is likely at the photoreceptor outer segmented-retinal pigmented epithelial junction [16].…”

“…However, to our knowledge, cases were not subgrouped as mild or severe before to compare the CMT with OCT. Although blunt eye trauma is one of the most common complaints of patients seen in emergency clinics, it was not until recently being investigated by sophisticated techniques such as OCT [15]. OCT can be a useful tool in the diagnosis and follow-up of eyes with Berlin's edema and may reveal ultrastructural macular changes because it enables clinicians to reliably detect and measure small changes in macular thickness and to evaluate the efficacy of different therapeutic modalities quantitatively [25].…”