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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 32

Choroidal rupture and macular hole secondary to blunt trauma


Department of Ophthalmology, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil

Date of Submission26-Mar-2022
Date of Decision26-Mar-2022
Date of Acceptance02-May-2022
Date of Web Publication23-Jun-2022

Correspondence Address:
Catherine Pancini Rezende
Pedro de Alcântara Camargo, 480, 13690000, Descalvado, São Paulo
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pajo.pajo_22_22

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  Abstract 


This is a retrospective case report of a male patient referred to the PUC Campinas Hospital as a victim of blunt car trauma. On ophthalmological examination, the patient had bilateral retinal changes in the foveal region, causing low visual acuity in both eyes. Knowing that ocular trauma is the main cause of legal blindness in working-age people, this study aimed to highlight the importance of ophthalmological evaluation to provide the necessary treatment and follow-up to minimize the ocular sequelae resulting from trauma.

Keywords: Blunt trauma, choroidal rupture, macular hole, ocular trauma


How to cite this article:
Rezende CP, de Souza FB, Peixoto BC, Ayres da Fonseca AL, de Andrade Sobrinho MV. Choroidal rupture and macular hole secondary to blunt trauma. Pan Am J Ophthalmol 2022;4:32

How to cite this URL:
Rezende CP, de Souza FB, Peixoto BC, Ayres da Fonseca AL, de Andrade Sobrinho MV. Choroidal rupture and macular hole secondary to blunt trauma. Pan Am J Ophthalmol [serial online] 2022 [cited 2022 Dec 7];4:32. Available from: https://www.thepajo.org/text.asp?2022/4/1/32/348003




  Introduction Top


Blunt trauma is an ophthalmologic emergency that must be managed in a way that minimizes damage to ocular tissues. The anamnesis and ophthalmological examination must be complete and include imaging resources if necessary, paying attention to possible changes and sequelae in the anterior and posterior segments of the eye. The objective of this study was to present a rare case of bilateral retinal changes in the foveal region after blunt trauma, reinforcing the importance of ophthalmologic evaluation in these patients.


  Case Report Top


A patient L.C.S.J., male, aged 19 years, a victim of an automobile accident (motorcycle versus pedestrian) at high speed (100 km/h), was referred to the PUC Campinas Hospital for evaluation due to multiple trauma fractures in the face and pelvis. The patient was hemodynamically stabilized and underwent fracture correction by the head and neck and orthopedic departments. Approximately 1 month after the trauma, an ophthalmology evaluation was requested due to the patient's low visual acuity (VA) complaint in both eyes, which has not been reported.

On ophthalmological examination, the patient had VA in the right eye (OD) counting fingers 2 m and in the left eye (OS) 20/120, with no changes on anterior biomicroscopy. Fundoscopy of the OD showed a linear lesion with a curved shape in the foveal region concentric with the optic nerve, suggestive of choroidal rupture [Figure 1], and a circular lesion with a clear and regular border in the macular region in the OS, suggestive of a macular hole [Figure 2].
Figure 1: Color fundus retinal photography showing choroidal rupture

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Figure 2: Color fundus retinal photography showing macular hole

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The diagnoses were confirmed by optical coherence tomography (OCT), which showed a rupture in the choriocapillaris and Bruch's membrane in the OD [Figure 3] and a full thickness macular hole in the OS [Figure 4]. Expectant management was chosen after discussing the condition with the patient and family members, who were warned about the reserved visual prognosis due to foveal involvement, possible surgical approaches if there was no spontaneous closure of the macular hole in the OS, complications such as the risk of choroidal neovascularization in the OD, and the importance of outpatient follow-up to monitor the case.
Figure 3: Optical coherence tomography showing choroidal rupture

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Figure 4: Optical coherence tomography showing macular hole

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  Discussion Top


Choroid rupture is a possible complication of blunt trauma to the posterior segment of the patient.[1] It has an essentially mechanical mechanism of injury, resulting from the compression of the eye along its anteroposterior axis during trauma, resulting in ruptures in the Bruch's membrane, which has little elasticity, in the retinal pigment epithelium, and in the choriocapillaris.[2] The lesions are curved, generally concentric to the optic nerve, with or without subretinal hemorrhage and Berlin edema.[2] Visual prognosis depends on the extent and location of the associated lesions, with permanent visual damage usually associated with foveal involvement.[3] Despite the relative prognosis and lack of effective treatment, patients with ruptures close to the macula should be advised regarding the need for monitoring to detect choroidal neovascularization, a possible complication of the condition.[4],[5]

A macular hole can also be a consequence of traumatic incidents.[6] The pathogenesis of this lesion involves several mechanisms, mainly necrosis and local vitreous traction.[7] Macular holes can be seen immediately after blunt trauma with severe commotio retinae, after submacular hemorrhage caused by a choroidal tear, or the separation of the vitreous from the retina.[2] The management of these conditions is controversial because posttraumatic holes can close spontaneously, probably secondary to the release of vitreous traction due to spontaneous posterior vitreous detachment or glial proliferation, or they can be closed surgically with success.[8] Visual prognosis depends on the degree of collateral damage to the fovea, persistence of foveal detachment after hole closure, and restoration of the layers of the inner and outer segments of photoreceptors.[2],[9] Therefore, the recovery of visual acuity among patients is variable.

Knowing that ocular trauma is the main cause of legal blindness in people of working age, resulting in a great socioeconomic impact,[10] when facing a trauma patient, health service teams should be instructed to request an ophthalmological evaluation when necessary. Ophthalmologists need to recognize possible changes in the anterior and posterior segments of the eye, including those reported in the study, and, in this way, provide the best available treatment/follow-up to minimize eye sequelae.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brazilian Ophthalmology Series. Retina and Vitreous. Brazilian Council of Ophthalmology, 2013-2014.  Back to cited text no. 1
    
2.
American Academy of Ophthalmology. Retina and vitreous retina. In: Basic and Clinical Science Course, 2021 2022.  Back to cited text no. 2
    
3.
Raman SV, Desai UR, Anderson S, Samuel MA. Visual prognosis in patients with traumatic choroidal rupture. Can J Ophthalmol 2004;39:260-6.  Back to cited text no. 3
    
4.
Ament CS, Zacks DN, Lane AM, Krzystolik M, D'Amico DJ, Mukai S, et al. Predictors of visual outcome and choroidal neovascular membrane formation after traumatic choroidal rupture. Arch Ophthalmol 2006;124:957-66.  Back to cited text no. 4
    
5.
Ament CS, Zacks D, Lane AM, D'Amico DJ, Young L, Mukai S, et al. Traumatic choroidal rupture: Visual outcome and treatment of choroidalneovascular membranes. Invest Ophthalmol Vis Sci 2002;43:4491.  Back to cited text no. 5
    
6.
Yanagiya N, Akiba J, Takahashi M, Shimizu A, Kakehashi A, Kado M, et al. Clinical characteristics of traumatic macular holes. Jpn J Ophthalmol 1996;40:544-7.  Back to cited text no. 6
    
7.
Gass JD. Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol 1995;119:752-9.  Back to cited text no. 7
    
8.
Inoue M, Arakawa A, Yamane S, Watanabe Y, Kadonosono K. Long-term outcome of macular microstructure assessed by optical coherence tomography in eyes with spontaneous resolution of macular hole. Am J Ophthalmol 2012;153:687-91.  Back to cited text no. 8
    
9.
Chen HJ, Jin Y, Shen LJ, Wang Y, Li ZY, Fang XY, et al. Traumatic macular hole study: A multicenter comparative study between immediate vitrectomy and six-month observation for spontaneous closure. Ann Transl Med 2019;7:726.  Back to cited text no. 9
    
10.
Thylefors B. Epidemiological patterns of ocular trauma. Aust N Z J Ophthalmol 1992;20:95-8.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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