An unusual complication of blunt ocular trauma: a horseshoe-shaped macular tear with spontaneous closure.

A case of horseshoe-shaped macular tear after blunt trauma with the course of the tear and the relevant findings obtained by spectral-domain optical coherence tomography (SD-OCT) is described. A 21-year-old man who had suffered blunt trauma 5 days previously visited our clinic complaining of vision loss in his left eye. Ophthalmic examination and SD-OCT images revealed a horseshoe-shaped macular tear. A month later at the second visit, the macular tear was found to have spontaneously closed. There have been many cases reported previously of the spontaneous closure of traumatic macular holes. A horseshoe-shaped macular tear is an atypical clinical presentation. However, the mechanism of spontaneous closure is hypothetically as same as that for a macular hole. High-resolution images and three-dimensional maps taken with SD-OCT can provide more details on macular diseases and are more useful than time-domain OCT images.

Comparison of grid laser, intravitreal triamcinolone, and intravitreal bevacizumab in the treatment of diffuse diabetic macular edema.

PURPOSE: To compare the effects of grid laser (GL), intravitreal bevacizumab (IVB), and intravitreal triamcinolone acetonide (IVTA) in diffuse diabetic macular edema (DDME). PROCEDURES: One hundred and twenty-six patients (126 eyes) treated with GL (modified grid), IVTA (4 mg), and IVB (1.25 mg) injections, matched for best corrected visual acuity (BCVA) and OCT-based central macular thickness at presentation, were enrolled. Primary outcome measure was change in best corrected logMAR visual acuity at 1-year follow-up. RESULTS: Rates of visual stabilization (within ±0.2 logMAR of baseline BCVA) (71.4, 83.3, 78.6%, respectively) were not different between the groups (p = 0.41) at 12-month follow-up. Higher rates of anatomical and functional success, however, were evident in IVB and IVTA groups within 6 months of treatment (p < 0.05 for both). No severe adverse effects except higher intraocular pressure (10 mm Hg from baseline) in one third (14 eyes) of the IVTA cases, who required trabeculectomy in 2 (4.8%) eyes, were observed. CONCLUSIONS: Intraocular injections may give favorable results within the first 6 months, and after 6 months, GL results seem to be more favorable in the treatment of treatment-naïve, acute, nonischemic, and center-involving DDME.

Outcomes of vitreoretinal surgery in patients with closed-globe injury.

PURPOSE: To evaluate the clinical features, visual outcomes, and prognostic factors in patients who underwent vitreoretinal surgery after closed-globe injury. METHODS: Retrospective review of patients with closed-globe injuries who underwent vitreoretinal surgery between January 2003 and December 2007. RESULTS: The study cohort included 46 eyes from 46 patients who underwent vitreoretinal surgery for posterior segment injury. Retinal detachment was the most frequent indication for the surgery, in 33 eyes (72%). After surgery, final visual acuity of 20/400 or better was achieved in 35 eyes (76%), while 11 eyes (24%) had visual acuity less than 20/400 (poor visual outcome). The most frequent reason for poor outcome was proliferative vitreoretinopathy (PVR) (6 eyes), followed by macular complications (3 eyes) and optic atrophy (2 eyes). Two cases with PVR became phthisical following repeated vitreoretinal procedures and also lost light perception. Prognostic factors associated with poor outcomes included delayed presentation, presenting visual acuity of less than 20/400, the presence of initial macular detachment, and the need for additional surgical intervention (p<0.05). No statistical difference was found in final visual acuity between eyes with or without retinal detachment (p>0.05). Also, the presence of damage to the anterior segment was not significantly associated with poor visual outcome (p>0.05). CONCLUSIONS: In patients with posterior segment pathology caused by closed-globe trauma, retinal detachment was the most common reason for vitreoretinal surgery and PVR was the main cause of surgical failure. The poor visual outcomes associated with delayed presentation suggest that patients need to be referred for further management.

Functional and structural analysis of partial optic nerve avulsion due to blunt trauma: case report.

Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury.