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Spontaneous Regression And Quiescence Of Choroidal Neovascularization Secondary To Traumatic Choroidal Rupture Depicted On Oct Angiography

Adhi, M. 2021Other/Unknown

Adhi, M., & Reinoso, M. (2021). Spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture depicted on OCT angiography. European journal of ophthalmology, 11206721211059030. Advance online publication. https://doi.org/10.1177/11206721211059030

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Abstract

INTRODUCTION: Choroidal rupture is a tear/break within the Bruch's membrane, retinal pigment epithelium and choroid following blunt trauma. Choroidal neovascularization is a well-known complication of traumatic choroidal rupture that is typically treated with intravitreal injections of Bevacizumab. This case describes an early detection of choroidal neovascular complex secondary to traumatic choroidal rupture and its spontaneous regression and quiescence without treatment followed using optical coherence tomography (OCT) angiography. CASE DESCRIPTION: A healthy 19 year old female presented with decreased vision in her left eye following a blunt non-penetrating closed globe injury two weeks prior. A complete ophthalmic examination with ancillary testing was consistent with sub-foveal choroidal neovascularization secondary to traumatic choroidal rupture. Five weeks later, there was spontaneous regression of the choroidal neovascular complex as depicted on OCT angiography and complete resolution of subretinal fluid/exudation on structural OCT. A conservative approach without intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections was chosen for management. CONCLUSION: To the authors' knowledge this is a first case describing a unique evolution with spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture without treatment followed using OCT angiography. Expectant management may be a viable treatment option for this condition.

Case Details

Disease Location

Retina

Personal Characteristics

19 year old female

Clinical Characteristics

Presented with decreased vision in her left eye following a blunt non-penetrating closed globe injury two weeks prior. On exam, her best corrected visual acuity was counting fingers at two feet in the left eye and 20/20 in the right eye. Intraocular pressure was 17 in the left 18 in the right eye. Slit lamp biomicroscopy of the left eye showed trace subconjunctival hemorrhage. Dilated fundus examination of the left eye was signficant for a fovea involving vertical choroidal rupture and overlying subretinal hemorrhage. Structural oct revealed a break in the retinal pigment epithelium and bruch’s membrane complex associated with subretinal hemorrhage and subretinal fluid. A diagnosis of active choroidal neovascularization secondary to traumatic choroidal rupture was made

Remission Characteristics

Five weeks later, her best corrected visual acuity was still counting fingers at two feet in the left eye. Dilated fundus examination and color fundus photography of the left eye showed resolving subretinal hemorrhage overlying the choroidal rupture involving the foveal center. Structural oct revealed sub-foveal fibrosis/scarring, improvement in subretinal hemorrhage, and complete resolution of subretinal fluid

Treatment & Mechanisms

Proposed Remission Mechanisms

The natural history of choroidal rupture associated choroidal neovascularization is spontaneous regression followed by its involution

Non-Clinical Treatment

None reported