Clinical histopathology of intra-choroidal splitting in open-globe injury–a retrospective case series of 4 patients

Abstract

Purpose : To observe the characteristics of intra-choroidal splitting (ICS) associated with choroidal detachment due to open-globe injury.

Methods : A retrospective observational case series study of 165 patients enrolled in the Eye Injury Vitrectomy Study (EIVS) that were diagnosed with choroidal detachment, 4 of whom exhibited ICS. The in vivo pathologic changes of the ICS were recorded during surgery. Four specimens were obtained from the inner part of the ICS region. One specimen was stained with hematoxylin and eosin; one specimen was examined under electron microscopy, and the other two specimens were examined under transmission electron microscopy.

Results : All four patients presented with vortex vein rupture associated with large-scaled mid-peripheral ICS. The histopathologic observations indicated that ICS occurred between the medium-sized and large-sized choroidal vessel layers. Large vascular indentations and medium-sized choroidal vessels were observed on the inner part of the split interface. Postoperative outcomes of the four patients were poor. Vision in all four patients was no light perception before or after surgery. Three eyes became atrophic with band-keratopathy, and one eye was eventually enucleated for cosmetic reasons.

Conclusions : ICS can occur during open-globe injury. The outcome of ICS with choroidal detachment was poor.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

The temporal keratoprothesis was applied in this patient. The brown sheet on the left ( star ) was the inner part of the choroidal schisis which includes RPE layer, Bruch`s membrane, choriocapillaris and medium sized chroidal vessel. Two parallel medium sized choroidal vessels crawling along the separated interface located next to the star mark. The sheet in red (triangle) was the outer part of the splitting choroid with hemorrhage, and this layer detached from the sclera. The right side of the peripheral region with spotted dark brown color (square) was the lamina fusca.

 

No RPE cells could be observed on the Bruch`s membrane where only some pigment particles were left. Spindle-like endothelium of the choriocapillaris was observed right under the Bruch`s membrane.An intact medium size choroidal vessel with vascular endothlium cells surrounded was filled with red blood cells. Between the Bruch`s membrane and the choroidal vessel was the chorodal melanocyte which was filled with dark granules.