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Joao Figueira, Cláudia Farinha, Ana R. Santos, Nuno Franqueira, Maria L. Cachulo, Isabel Pires, Rufino Silva; Microstructural and Functional Changes in Patients with Commotio Retinae. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2158.
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© ARVO (1962-2015); The Authors (2016-present)
Evaluation of morphological and functional changes associated with commotio retinae secondary to blunt trauma observed in the last five years in the Department of Ophthalmology of HUC.
Retrospective, consecutive case series of commotio retinae associated with blunt trauma from the last five years recorded in the files available on the Department. Patients were evaluated with a complete eye examination, VA with ETDRS chart and SD-OCT and FAF. Analysis of demographics, causes of injuries, associated morphological and functional changes, type of treatment, sequelae and duration of follow-up were registered.
We obtained records of 22 Eyes of 22 patients with commotio retinae who met the selection criteria. The majority were male (90,9%) with a mean age of 32, 5 years and with a history of aggression, car crash or work accident. The initial mean BCVA was 1,06 LogMAR and the final mean BCVA was 0,70 LogMAR (p=0,008). At baseline OCT showed predominantly changes at the level of the retinal pigment epithelium (RPE) (62,5%) and photoreceptor outer segment (POS) (62,5%), as well as an hiperreflectivity in the internal layers of the retina (100%). The final OCTs revealed the same changes at the level of the RPE (66,7%) and POS (76,2%) and foveal atrophy (42,9%). The OCT was normal in 19,1%. On FAF patients with no sequelae on fundoscopy and OCT had a normal FAF, but those with signs of atrophy developed hipohiperautofluorescent plaques. The treatment was conservative/medical except in cases of associated pathology like macular hole, CNV secondary to choroidal rupture or RD/T. The cases with poorer visual acuity (VA) were usually those associated with macular holes and those with permanent macular changes in the layers of the RPE and at the junction of the outer / inner segment of the photoreceptors.
Ocular trauma is globally a leading cause of vision loss. Commotio retinae in most cases has good prognosis, but in more severe cases it may be associated with a traumatic pigment epitheliopathy related to sustained loss of visual acuity. These findings are related with permanent damage in the outer layers of the retina and RPE on OCT.
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