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CS Ament, D Zacks, AM Lane, DJ D'Amico, L Young, S Mukai, J Loewenstein, E Gragoudas, J Arroyo, J Miller; Traumatic Choroidal Rupture: Visual Outcome and Treatment of Choroidalneovascular Membranes . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4491.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine predictors of choroidal neovascularization and visual outcome after traumatic choroidal rupture. Methods: A retrospective chart review of patients with traumatic choroidal rupture diagnosed in the Retina service at the MEEI between 1993-2001 was performed. A minimum of three-month, post-trauma follow-up was required for inclusion. Parametric and non-parametric statistical methods were employed to evaluate visual outcome. Results: 110 cases were identified and reviewed. 38 of 110 (35%) patients recovered driving (20/40 or better) vision. Recovery of driving vision was seen in 20 of 34 (58%) of eyes with peripheral choroidal ruptures, 16 of 72 (22%) of eyes with macular choroidal ruptures, 38 of 99 (38%) of eyes without CNV and 0 of 11 (0%) of eyes with CNV, 37 of 95 (39%) of eyes without retinal detachment and 1 of 15 (7%) eyes with retinal detachment. Older age (p=0.03), location of rupture within the arcades (p<0.001), and multiple choroidal ruptures (p=0.02), were positively associated with CNV formation. Retinal detachment (p=0.02), development of CNV (p=0.02), and macular location of rupture (p<0.001) were associated with failure to recover driving vision. Open- versus closed-globe injury and concomitant ocular injuries were not associated with visual outcome or CNV formation. Peripheral choroidal rupture (p<0.001) was associated with retinal detachment. Results: Of 11 patients diagnosed with CNV, 5 were not treated, 4 were treated with argon laser photocoagulation, one was treated with argon laser followed by surgery, and one was treated with PDT. Of the 5 untreated patients, none recovered visual acuity greater than 20/100. Of the four treated with laser, one recovered VA of 20/32, none of the others recovered visual acuity greater than 20/160; recurrent CNVM was diagnosed in one patient and was not re-treated. The patient treated with laser and surgery achieved a final VA of 20/400, and developed recurrent CNV that was not treated. The final patient was treated with two sessions of PDT and achieved final VA of 20/40. Conclusion: Most patients with choroidal rupture do not achieve a final VA of 20/40 or better. Poor visual outcome is most highly associated with macular rupture, CNV formation, and retinal detachment. CNV formation was most strongly associated with older age and macular choroidal rupture. Treatment for CNV includes observation, photocoagulation, surgery, and PDT; because of small sample size we cannot make recommendations regarding treatment.
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