PHOTOGALLERY OF CLINICAL OPHTHALMOLOGY

Giant annular posttraumatic choroidal rupture

Nichard Unonius, MD; Jodeilson Araujo, MD; Michel E. Farah, MD; Juliana M. Ferraz Sallum, MD; Daniela Calucci, COMT

Choroidal rupture is a common complication of ocular blunt trauma, with various degrees of

injury to the choriocapillaris, choroidal vessels, Bruch's membrane, retinal pigment epithelium (RPE) and retina. We present an imaging correlation of a giant annular posttraumatic choroidal rupture around the optic disc and macula.

CASE REPORT

A 22-year-old man incurred a closed injury to his right eye from a tennis ball 11 days before examina­tion. His best-corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye. The intraocular pressure was 16 mm Hg in the right eye and 13 mm Hg in the left eye. Right fundus examination showed a choroidal rupture of nearly 31 oo with linear extension of 16.5 mm around the optic disc and the macula, sparing the fovea and a small portion of the superotemporal region (Fig. 1, A). Fluorescein angiog­raphy of the lesion showed transmitted hyperfluores­cence (Fig. 1, Band C). Indocyanine green angiogra­phy (ICGA) demonstrated lesion hypofluorescence (Fig. 1, D and E). Optical coherence tomography did not show any alteration (Fig. 1, F). The left eye was normal.

From the Department of Ophthalmology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil

Originally received Sept. 18, 2002 Accepted for publication Apr. 9, 2004

Correspondence to: Dr. Michel E. Farah, Av. Ibijau, 331,4° andar, Sao Paulo - SP, Brazil, 04524-020; fax 55(11)241 6998, mefarah@uol. com.br

This article has been peer-reviewed.

Can J Ophthalmol 2004;39:538-9

538 Giant annular choroidal rupture-Unonius et a1

COMMENTS

In patients with giant annular choroidal rupture, a window defect, leakage and staining on fluorescein angiography may be seen. 1 In our patient, only trans­mitted hyperfluorescence was present. Such ruptures may be categorized as incomplete or complete, accord­ing to the findings on ICGA. This imaging technique may show hypofluorescence due to edema from rup­ture of the RPE or the choriocapillis.2 The linear hypo­fluorescence of our patient's lesion on ICGA was caused by nonperfusion of the lesion, which was more evident in the later phase. In cases in which there is subretinal hemorrhage with associated hyperfluores­cence, ICGA can demonstrate lesions that may not be visible on fluorescein angiography.3 In our case optical coherence tomography was able to demonstrate focal thickness of the RPE, but no alterations, such as tears or detachments, were evident.

Periodic observation is recommended in patients with giant annular choroidal rupture owing to the risk of subretinal neovascularization, which may require clinical or surgical intervention. However, this com­plication is rare. 3

REFERENCES

1. Hart JCD, Natsikos VE, Raistrick ER, Doran RML. Indirect choroidal tears at the posterior pole: a fluorescein angiographic and perimetric study. Br J Ophthalmol 1980;30:59-67.

2. Arend 0, Remky A, Elsner AE, Wolf S, Rein M. lndo­cyanine green angiography in traumatic choroidal rup­ture: clinicoangiographic case reports. Ger J Ophthalmol 1995;4(5):257-63.

3. Baltatzis S, Ladas ID, Panagiotidis D, Theodossiadis GP. Multiple posttraumatic choroidal ruptures obscured by hemorrhage: imaging with indocyanine green angiogra­phy. Retina 1997;17:352-4.

Key words: rupture; choroid; wounds, nonpenetrating; eye injuries

Giant annular choroidal rupture-Vnonius et al

Fig. 1-A: Fundus photograph, showing 31 0° giant annular choroidal rupture around optic disc and macula, sparing fovea. B, C: Fluorescein angiograms. Early phase (B) shows beginning window defect hyperfluorescence of lesion; late phase (C) shows persist­ence of transmitted fluorescence. D, E: Early-phase (D) and late-phase (E) indocyanine green angiograms, showing hypofluorescence due to nonperfusion. F: Optical coherence tomography image through choroidal rupture, showing normal sensory retina and retinal pigment epithelium.

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