Outer Retinal Structure Following Closed Globe Blunt Ocular Trauma

Abstract

 

Purpose

 

Closed globe blunt ocular trauma (cg-BOT) can result in vision loss that often cannot be clinically explained. Involvement of the posterior segment is often linked to poor visual outcomes, possibly due to chronic changes in retinal architecture. Currently, little is known on the impact of cg-BOT on photoreceptor structure. Here we used high-resolution retinal imaging to evaluate outer retinal structure in patients with visual deficits secondary to cg-BOT.

 

Methods

 

Imaging was performed between 1 mo and 3 yrs post-trauma. Fundus photography and spectral domain optical coherence tomography (SD-OCT) were used to assess macroscopic changes in retinal architecture in 8 subjects with cg-BOT. Adaptive optics scanning light ophthalmoscopy (AOSLO) was used to analyze the integrity of the photoreceptor mosaic, and Bioptigen SD-OCT was used to obtain high-resolution line scans through the fovea.

 

Results

 

Examined subjects had documented visual deficits ranging from central scotoma to larger field deficits and decreases in visual acuity. Acutely, 4 subjects had documented commotio retinae (CR) of the macula, 1 had peripheral CR, and 2 had choroidal rupture. SD-OCT revealed variable disruption of outer retinal architecture, whereas AOSLO revealed a disrupted foveal cone mosaic in all eyes. Cone mosaic disruption correlated with the extent of outer retinal disruption observed with SD-OCT. In addition, decreased cone density with local expansion of rods was seen in the perifoveal region in 3 eyes. Six eyes contained patches of non-waveguiding cones within the macula.

 

Conclusions

 

SD-OCT and AOSLO revealed outer retina structural deficits in individuals with varying degrees of injury following cg-BOT. AOSLO imaging provides a noninvasive way to assess photoreceptor structure at a level of detail not resolvable using conventional SD-OCT or other clinical imaging tools. It also appears useful for revealing the cause of visual complaints in patients following cg-BOT.

 

 

30 y/o male sustained cg-BOT, presented clinically with a small central scotoma OS and macular CR. BCVA was 20/20 OU. A) 6mm SD-OCT. B) AOSLO montage corresponding to arrows in A. C) Cut out from B revealing non-waveguiding cones.

 

 

34 y/o male sustained cg-BOT, presented clinically with a small central scotoma OD and peripheral CR. BCVA was 20/40 OD. A) 6mm SD-OCT. B) AOSLO montage corresponding to arrows in A. C) Cut out from B revealing focal disruption of photoreceptor mosaic.

 

Keywords: 742 trauma • 585 macula/fovea • 551 imaging/image analysis: non-clinical