Long-term Improvement of a Traumatic Sub-foveal Choroidal Neovascularization in a Child with a Single Intravitreous Triamcinolone Acetonide Injection

Abstract

Abstract: : Purpose:To describe the fluorescein angiogram (FA) findings and best-corrected visual acuity (BCVA) data from a one-year follow up of successfully treated traumatic choroidal neovascularization (CNV) in a 9-year old child’s eye using a single dose of intravitreous triamcinolone acetonide (iTA). Methods:Blunt closed ocular trauma (BCOT) from a baseball injury to the left eye. Severe posterior pole edema was noted initially with 20/400 vision, which spontaneously returned to 20/20. Three months post-injury, the eye developed subfoveal CNV with hemorrhage and vision dropped to 20/400. FA demonstrated a CNV lesion with hemorrhage. The eye was treated with iTA under general anesthesia. Visual acuity, sequential fundus photographs, and/or FAs were performed at periodic intervals and will be depicted. Results:The macula of the left eye demonstrated CNV with associated hemorrhage beneath the fovea at 3 months following blunt closed occur trauma. A choroidal rupture was presumed, but could not be identified clinically. Vision was severely reduced to 20/400. Subfoveal CNV from traumatic choroidal rupture has a poor prognosis with any treatment. Subfoveal surgery, photodynamic therapy (PDT), transpupillary thermotherapy (TTT) and conservative management with no treatment were considered. Ultimately, intravitreous triamcinolone acetonide, 4 mg, was injected. Progressive resolution of the blood and subretinal fluid over several months was associated with improved vision back to 20/30. FA demonstrated regression and disappearance of the CNV lesion leaving only a glial scar. No evidence of glaucoma or cataract has occurred. No recurrence has been observed at one-year follow up. Conclusions: CNV is a rare complication of blunt closed ocular trauma. Treatment success is rare with preservation of vision. Corticosteroids have been shown to reduce choroidal revascularization in experimental CNV and in human eyes with CNV from Age-Related Macular Degeneration (AMD). This report demonstrates a long-term beneficial effect of iTA in the treatment of CNV secondary to trauma with presumed choroidal rupture in a child. This modality should be considered in similar cases because of the long-term visual and anatomic success and lack adverse sequellae.

Keywords: trauma • choroid: neovascularization • wound healing