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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Retina

Case 85

Patient presentation: A 29-year-old man was referred to a tertiary retina clinic with acute, unilateral vision loss in the left eye following traumatic injury involving the left globe and the left side of his head. The patient subsequently presented to his local emergency department where neuroimaging was performed, which did not demonstrate any acute intracranial abnormalities. He also sustained a full thickness left upper eyelid laceration, which was repaired with primary closure. He had no significant past medical or ocular history and did not take any medications.

On initial examination, his best-corrected distance visual acuity was 20/30 OD and 20/400 OS. The intraocular pressure was 13 mmHg OD and 10mmHg OS. Anterior segment examination demonstrated a microhyphema OS; the anterior chamber was deep and quiet OU. Dilated fundus examination was performed and is shown below:

Question 1: What are the key findings in the fundus photographs shown above?

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An OCT Macula was performed and is shown below:

Question 2: What are the key findings in the OCT Macula images shown above?

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Question 3: Given this patient’s clinical history, fundus findings, and OCT findings, what is the most likely diagnosis?

A. Choroidal rupture OS

B. Retinal detachment OS

C. Exudative age-related macular degeneration OS

D. Polypoidal choroidal vasculopathy OS

Question 4: Which of the following is NOT a known complication associated with choroidal rupture?

A. Traumatic optic neuropathy

B. Macular neovascularization

C. Angle recession glaucoma

D. Venous sinus thrombosis

Question 5: What is the most appropriate treatment at this time?

A. Anti-VEGF therapy

B. Intravitreal dexamethasone implant

C. Photodynamic therapy

References:

Lupidi M, Muzi A, Castellucci G, et al. The choroidal rupture: current concepts and insights. Surv Ophthalmol 2021;66(5):761-770.

Learning Objectives:

To understand the history, exam findings, and management of choroidal rupture.
To recognize the importance of routine follow-up in patients with choroidal rupture.

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