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Traumatic Maculopathy with Massive Subretinal Hemorrhage after Closed-Globe Injuries

Authors :
Chi-Chun Lai
Ming-Hui Sun
Chiun-Ho Hou
Nan-Kai Wang
Wei-Chi Wu
Chi-Chin Sun
An-Lun Wu
Kuan-Jen Chen
Source :
Ophthalmology Retina. 3:53-60
Publication Year :
2019
Publisher :
Elsevier BV, 2019.

Abstract

Purpose To investigate the visual outcomes of patients with traumatic maculopathy and massive subretinal hemorrhage (SRH) after closed-globe injury. Design Retrospective, noncomparative, and interventional case series. Participants Twenty-four patients with traumatic maculopathy and massive SRH after closed-globe injury. Methods In this retrospective observational case series, we included 25 eyes of 24 patients who had experienced closed-globe injury with massive SRH. Main Outcome Measures The demographics, clinical characteristics, and final visual acuity (VA) of the patients. Results Twenty-five eyes with massive SRHs involving the macula were studied with initial VAs from light perception to 4/200. At initial presentation, vitreous hemorrhages were present in 22 eyes, hyphema in 13 eyes, lid lacerations in 11 eyes, glaucoma in 8 eyes, iridodialysis in 7 eyes, afferent pupillary defect in 6 eyes, lens dislocation or subluxation in 5 eyes, and cyclodialysis clefts and hypotony in 2 eyes. Retinal detachment developed in 7 eyes during the follow-up period. Pars plana vitrectomy usually was performed in patients with persistent vitreous hemorrhage, retinal detachment, lens dislocation, and cyclodialysis cleft with hypotony. In final visual outcomes, 7 eyes achieved favorable visual outcomes with VA of 20/200 or more. Thirteen eyes showed VA of 2/200 or less with dense macular scars or foveal atrophy. Foveal atrophy showed encompassed foveal thinning, retinal pigment epithelial clumping, and the loss of external limiting membrane (ELM), ellipsoidal zone (EZ), and interdigital zone (IZ) on spectral-domain OCT. Fundus autofluorescence demonstrated interposed, reduced, and increased autofluorescence in traumatic pigment epitheliopathy. Conclusions Traumatic maculopathy and massive SRH after closed-globe injury often cause poor visual outcomes, especially in eyes with dense macular scars or foveal atrophy. Spectral-domain OCT findings in patients with good visual outcomes revealed partial to complete preservation of the foveal ELM, EZ, and IZ.

Details

ISSN :
24686530
Volume :
3
Database :
OpenAIRE
Journal :
Ophthalmology Retina
Accession number :
edsair.doi...........1dafa8a28ef8c9288134147906dd9a10
Full Text :
https://doi.org/10.1016/j.oret.2018.08.007