Traumatic choroidal injuries - classification, incidence, diagnosis and prognosis twenty-year results of Eye Injury Vitrectomy Study.

PURPOSE: To characterize the classification, incidence, diagnosis and prognosis of traumatic choroidal injuries. METHODS: Subjects were selected from the database of the Eye Injury Vitrectomy Study (EIVS) and were examined for occurrences of different categories of choroidal injuries. Standard photographs were collected. Anatomical and visual outcomes were assessed in patients with greater than 1 year of follow-up. Eyes that had no light perception (NLP) and/or phthisis bulbi were defined as having had unfavourable outcomes. The percentage of eyes with an unfavourable outcome was analysed for different types of choroidal injuries. RESULTS: Nine categories of choroidal injuries with distinctive features were identified in the EIVS database. The incidence and the percentage of eyes with an unfavourable outcome in each injury category were as follows: suprachoroidal effusion, 21.2% (7.2%); suprachoroidal haemorrhage, 12.8% (11.2%); massive suprachoroidal haemorrhage, 4.0% (64.9%); choroidal avulsion, 4.2% (92.2%); traumatic chorioretinal rupture, 1.8% (13.3%); choroidal rupture, 4.8% (6.8%); choroidal loss, 1.6% (79.3%); choroidal hole, 1.1% (5.3%); and choroidal damage at the wound site, 39.2% (17.7%). CONCLUSIONS: Ocular trauma can cause a variety of choroidal injuries that have distinctive features, some of which are associated with a high frequency of unfavourable prognoses.

Choroidal vascular changes in age-related macular degeneration: A protocol for systematic review and meta-analysis.

BACKGROUND: As an increasing age-related eye disease, age-related macular degeneration (AMD) is becoming a common cause of irreversible visual loss in elder population. The mechanism of AMD remains uncertain and covers a complex risk factors. Choroidal vascularity index (CVI) is a sensitive parameter obtained by enhanced depth imaging of optical coherence tomography which allows the choroid in more detail and accurate assessment in the pathogenesis of AMD. The objective of this current study is to evaluate choroidal structural alternations measured by CVI in AMD. METHODS: We will review 4 English databases (PubMed, Embase, Cochrane Library, and Web of Science) from their inception until present to select eligible articles. English-language and case-control studies will be accepted. The data extraction content and quantitative analysis will be performed systematically by 2 independent authors. The primary outcome is the alternation of CVI in AMD. The secondary outcomes consist of choroidal thickness (CT), luminal area (LA), stromal area (SA), and total choroidal area (TCA). Subgroup analysis, sensitivity analysis, and publication bias will be performed to check the robustness of the pooled outcome data. RESULTS: Changes of quantitative parameters such as CVI will be obtained in patients with AMD. CONCLUSION: This study will elucidate alternations of choroidal vascular and stromal component in AMD and provide robust evidence on the pathophysiology of AMD. REGISTRATION NUMBER: INPLASY.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN A CASE OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO TRAUMATIC CHOROIDAL RUPTURE.

BACKGROUND/PURPOSE: To document by optical coherence tomography angiography, the onset of a choroidal neovascularization (CNV) secondary to traumatic choroidal rupture and describe its changes after an intravitreal injection of bevacizumab. METHODS: Case report. RESULTS: A 20-year-old woman presented referring vision loss after a blunt ocular trauma in her left eye. The patient underwent a complete ophthalmic examination. Best-corrected visual acuity was 20/200. Fundus examination, fluorescein angiography, indocyanine green angiography, and optical coherence tomography displayed a choroidal rupture with no evidence of CNV. Optical coherence tomography angiography showed the choroidal rupture as a line of choriocapillaris rarefaction because of the mechanical damage. Six months later, best-corrected visual acuity decreased to 20/300; optical coherence tomography angiography displayed the growth of a CNV, characterized by a tangled vascular network. After one intravitreal injection of bevacizumab, optical coherence tomography angiography documented a contraction of the CNV. CONCLUSION: Optical coherence tomography angiography is a useful imaging technique for the diagnosis and follow-up of patients with choroidal ruptures. Anti-vascular endothelial growth factor agents represent an effective therapy for the treatment of CNVs secondary to this affection.

Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to traumatic choroidal rupture.

BACKGROUND: So far only single cases with short follow-up have been reported on the use of intravitreal anti-VEGF for traumatic choroidal neovascularizations (CNV). This paper reports a large case series of patients with CNV secondary to choroidal rupture after ocular trauma receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections. METHODS: Fifty-four patients with unilateral choroidal rupture after ocular trauma diagnosed between 2000 and 2016 were retrospectively evaluated. Eleven patients with CNV secondary to choroidal rupture were identified. Five eyes with traumatic secondary CNV were treated with anti-VEGF and were systematically analysed. The other 4 patients with inactive CNV underwent watchful observation. RESULTS: Four men and one woman with a mean age of 29 years (SD 12.4; range 19-45) had intravitreal anti-VEGF therapy for traumatic CNV. Another 4 patients with a mean age of 37 years (SD 6.6; range 31-46) presented with inactive CNV and did not receive specific treatment. In all 9 cases the mean interval between the ocular trauma and the diagnosis of CNV was 5.7 months (SD 4.75; range 2-12). In the treatment group per eye 4.2 injections (SD 3.2; range 1-8) were given on average. Four eyes were treated with bevacizumab and one eye with ranibizumab. Regression of CNV was noted in all eyes. In 4 eyes visual acuity (VA) improved, one eye kept stable visual acuity. CONCLUSIONS: Here, we present the up to now largest case series of traumatic CNV membranes treated with anti-VEGF injections with a mean follow-up period of 5 years. Intravitreal anti-VEGF therapy seems to be safe and effective for secondary CNV after choroidal rupture. Compared to exudative age-related macular degeneration fewer injections are needed to control the disease. TRIAL REGISTRATION: Retrospective registration with local ethics committee on 21 March 2019. Trial registration number is 19-1368-104.

Pathomechanism of traumatic indirect choroidal rupture.

The probable chain of events responsible for choroidal rupture is as follows. During high-speed orbital injuries, the protective ocular reflexes position the eye in an elevated, and abducted position. At this point in time, the anteroposterior compressive forces on to the globe create an eccentrically positioned circle of damaging currents along the posterior ocular coats against a relatively static optic nerve. Because of this eccentricity, a longer radius of curvature is expected to lie along the temporal half of the globe leading to an elastic recoil of the retinal and scleral layers and a fracture along the RPE-Bruch's-Choriocapillaris complex manifesting clinically as choroidal rupture.

Posttraumatic acute choroidopathy.

PURPOSE: To report a case of acute choroidopathy following a blunt ocular trauma. METHODS: Ocular examination included dilated fundus examination and optical coherence tomography enhanced depth imaging (OCT-EDI). PATIENTS: Single-patient case report. CASE REPORT: A 10-year-old boy was referred following a blunt trauma to the right eye. The visual acuity diminished to 20/200 and mild hemorrhage was found in the anterior chamber. The fundoscopy was unremarkable. An OCT-EDI revealed a choroidal thickening and detachment at the macula. Six month later, the choroidal morphology resolved and the visual acuity improved. CONCLUSIONS: This study reported a case of acute choroidopathy associated with temporary thickening of the choroid and separation of the Haller's layer from the sclera. OCT-EDI helped to detect and monitor the morphological changes in the apparently normal-looking macular choroid after ocular trauma. Further case reports with long term follow-up are needed to clarify the clinical impact of posttraumatic acute choroidopathy.

Opthalmological sequelae due to paintball injuries: Case studies. / Secuelas oftalmológicas por traumatismo con paintball: estudio de casos.

OBJECTIVE: Describe the ophthalmological sequelae of patients diagnosed with blunt eye injury by paintball. MATERIAL AND METHODS: There were a total 14 cases with a diagnosis of blunt trauma by paintball were treated at the ophthalmology emergency department of the Barraquer Clinic in Bogotá, Colombia. All patients underwent a complete ophthalmological examination with their respective controls according to their outcome. RESULTS: The frequency of eye trauma by paintball was 3.01%. Fourteen eyes were evaluated, age range from 9 to 49 years. Cases were unilateral, 1 woman and 13 men, initial visual acuity less than 20/30 in 12 eyes. Only 5 eyes progressed satisfactorily, and 3 were surgically intervened. The cases that did not show any improvement in visual acuity were related to posterior pole problems, with the most frequent being macular alterations, choroidal rupture, choroidal detachment, retinal tear, and retinal folds. In 3eyes, clinical improvement of visual acuity was evidenced secondary to haemorrhagic processes that resolved with medical treatment. One of them underwent surgical treatment of the lens with an intraocular lens implant. In 2eyes, the visual recovery was very satisfactory and 100% in another. CONCLUSION: Paintball has increased as a sport and recreational activity, where paint projectiles are fired with compressed air weapons. It carries risks of suffering various trauma that can lead to catastrophic episodes, in terms of visual health, and repercussions on the quality of life of those affected.

Prophylactic Chorioretinectomy in Open Ocular Trauma: A Series of 36 Eyes.

PURPOSE: The aim of this paper was to report the outcomes of prophylactic chorioretinectomy in open-globe injuries where a foreign body penetrated the choroid or perforated the globe. METHODS: We conducted a retrospective, consecutive, noncomparative, and descriptive study of patients registered in the ocular trauma database between January 2006 and December 2014, who underwent vitrectomy with chorioretinectomy. RESULTS: Thirty-six patients (33 male, 3 female) with a mean age of 40 years and a median of follow-up of 13 months were included. Twenty-one cases had penetrating globe injuries with an intraocular foreign body and 15 cases had perforating globe injuries. A concomitant chorioretinectomy was performed in all eyes, although it was only partial in 8 eyes. At the end of follow-up, proliferative vitreoretinopathy (PVR) rates were 6.5%, anatomical success was 80.6%, and the globe survival rate was 96.8%. CONCLUSION: Prophylactic chorioretinectomy is a surgical procedure that may decrease posttraumatic PVR, thus improving final visual acuity and increasing globe survival rates.

EN-FACE OPTICAL COHERENCE TOMOGRAPHY IMAGING IN A CASE OF CHOROIDAL RUPTURE.

PURPOSE: To report a case of choroidal rupture resulting due to blunt trauma using en-face optical coherence tomography (OCT) imaging. METHODS: Case report. RESULTS: A 22-year-old man sustained a blunt trauma to his right eye. At the initial examination, four lesions with a subretinal hemorrhage were observed during a fundus examination of the macular area including the fovea, but the findings under the lesions were unclear. The authors observed the extent of the minute findings noninvasively by en-face OCT imaging from the initial examination. Six months after the trauma, the fine crescent-shaped lines seen by angiography and OCT B-scan images were consistent with findings observed on the en-face OCT images. CONCLUSION: The en-face OCT imaging would be useful to examine the pathological changes in a choroidal rupture noninvasively during frequent follow-up examinations in a case of choroidal rupture.