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 Table of Contents  
OPTHA INSTA
Year : 2021  |  Volume : 33  |  Issue : 2  |  Page : 123-125

Acute traumatic maculopathy


1 Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India
2 Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India
3 Department of Paediatric Ophthalmology and Strabismus, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India

Date of Submission04-Aug-2020
Date of Acceptance28-Aug-2020
Date of Web Publication21-Aug-2021

Correspondence Address:
Dr. Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Private Limited, No. 6, Tennur, Seshapuram, Trichy - 620 017,Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_116_20

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  Abstract 


Traumatic retinopathy may occur secondary to direct or indirect trauma to the globe. Presentation of retinopathy may either be a coup (direct site of injury) and or contre-coup (distant sites including the macula). Commotio retinae in the posterior pole is referred to as Berlin's edema. The fovea is extremely thin, and blunt trauma may cause a full-thickness macular hole by either one or a combination of mechanisms, including contusion necrosis and vitreous traction. Holes may be noted immediately or soon after blunt trauma due to severe Berlin's edema, or after a subretinal hemorrhage caused by a choroidal rupture, or following severe cystoid macular edema, or after a whiplash separation of the vitreous from the retina. Post-traumatic macular holes (TMHs) may be successfully closed with vitrectomy and gas injection. We report a case of blunt trauma leading to Berlin's edema and TMH.

Keywords: Berlin's edema, blunt trauma, traumatic macular hole


How to cite this article:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Acute traumatic maculopathy. Kerala J Ophthalmol 2021;33:123-5

How to cite this URL:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Acute traumatic maculopathy. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Dec 5];33:123-5. Available from: http://www.kjophthal.com/text.asp?2021/33/2/123/324209



A 20-year-old male patient presented with an injury to the left eye with a cricket ball following which he experienced a sudden loss of vision. He had a visual acuity of 20/400 in the left eye. On evaluation, anterior segment was normal. Fundus evaluation revealed Berlin's edema with traumatic macular hole (TMH) [Figure 1]a. Optical coherence tomography (OCT) macula revealed full-thickness macular hole with retinal thickening and para-foveal disruption of the outer segment [Figure 1]b.
Figure 1: (a) Color fundus photograph OS showing yellowish discoloraton of macula with central red lesion revealing Berlin's edema and traumatic macular hole with disc haemorrhage. (b) Optical coherence tomography (OCT) macula revealed full-thickness macular hole with retinal thickening and para-foveal disruption of the outer segment

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Blunt trauma causes expansion of the globe in the equatorial region, which leads to a combination of anteroposterior vitreoretinal and tangential retinal traction, leading to a central defect in the fovea.[1],[2]


  Clinical Finding Top


This acute traumatic maculopathy presented with TMH with Berlin's edema.

Clinical

Fundus examination reveals glistening gray-white opacification of the neurosensory retina in the macula region, mimicking a pseudo cherry-red spot with a round or ellipsoid full-thickness defect of the neurosensory retina [Figure 1]a.[3]

Optical coherence tomography

Optical coherence tomography (OCT) macula revealed full-thickness macular hole with retinal thickening and parafoveal disruption of the outer segment [Figure 1]b.

Sequelae

At 3 months follow up, patient presented with a fundus photograph [Figure 2]a revealing macular scarring with reduction of glistening cherry red spot and resolved disc haemorrhages. The OCT macula [Figure 2]b revealed macular scarring with complete disruption of the outer segment and inner segment /outer segment junction.
Figure 2: (a) Color fundus photograph OS showing yellowish discoloraton of macula with central red lesion revealing Berlin's edema and traumatic macular hole with disc haemorrhage. (b) Optical coherence tomography (OCT) macula revealed full-thickness macular hole with retinal thickening and para-foveal disruption of the outer segment

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Seen in

This condition is seen in activities associated with blunt trauma to the face and orbits, especially high-impact sports activities (commonly ball sports), violence, and motor vehicle accident.

Who described it?

  • Berlin's edema - First described by Berlin in 1873
  • Macular hole - First described by Knaap in the late 1869 and later described by Noyes in 1875.


Cardinal diagnostic features?

Diagnosis is clinical and is made based on the characteristic appearance. However, OCT is imperative in diagnosing and managing this disorder. It provides a high-resolution image for the evaluation of macula in cross-section and three-dimensional view. OCT can help detect subtle TMHs as well as stage obvious ones.

Why it occurs?

Blunt trauma causes displacement of the lens-iris diaphragm with the expansion of peripheral structures outward. This causes stretching and tearing of ocular tissues, secondary to vitreoretinal deformation caused by the transmission of hydraulic forces. The retina is inelastic and absorbs the full effect of shock waves, resulting in injury to various layers mainly the outer segment of photoreceptor and retinal pigment epithelium (RPE) junction causing Berlin's edema.

The hypotheses behind the development of TMHs are the tangential and anteroposterior vitreoretinal traction.

What else to examine?

Rule out the seven rings of trauma:

  1. Sphincter pupillae tear
  2. The iris base for iridodialysis
  3. Anterior ciliary body trauma
  4. Separation of ciliary body from scleral spur
  5. Trabecular meshwork tear/flap
  6. Zonular dialysis
  7. Retinal attachment at ora serrata.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that his names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Budoff G, Bhagat N, Zarbin MA. Traumatic macular hole: Diagnosis, natural history, and management. J Ophthalmol 2019;2019:5837832.  Back to cited text no. 1
    
2.
Johnson RN, McDonald HR, Lewis H, Grand MG, Murray TG, Mieler WF, et al. Traumatic macular hole: Observations, pathogenesis, and results of vitrectomy surgery. Ophthalmology 2001;108:853-7.  Back to cited text no. 2
    
3.
Blanch RJ. Understanding and preventing visual loss in commotio retinae, in College of Medical and Dental Sciences. University of Birmingham: Birmingham, UK: University of Birmingham; 2014. p. 581.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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