OCT III imaging of whiplash maculopathy

SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN A CASE OF WHIPLASH MACULOPATHY WITH INCOMPLETE RESOLUTION

PURPOSE

To report spectral domain optical coherence tomography (OCT) findings of a patient who experienced bilateral visual loss after a motorcycle accident.

METHODS

A 51-year-old man presented to the emergency department complaining of bilateral visual loss after a motorcycle falling down. A complete ophthalmologic examination and OCT testing were made on the same day of the accident. Follow-up was made at 2 days, 2 weeks, 5 months, and 12 months adding central visual field assessment using Humphrey automated perimetry.

RESULTS

At presentation, best-corrected visual acuity was 20/200 in both eyes, anterior segment was normal, and fundus examination showed a bilateral macular edema confirmed by OCT. After 2 days, visual acuity recovered to 20/25. Optical coherence tomography findings showed foveal detachment, hyperreflective clump below external limiting membrane, and hyperreflectivity of Henle layer nasally to the fovea. After 15 days, visual acuity was 20/20, but vision was altered by a paracentral scotoma and some irregularities of OCT findings persisted. At 1 year of follow-up, best-corrected visual acuity was 20/20, and paracentral scotoma was very tiny in the right eye, whereas larger and deeper in the left eye. Optical coherence tomography was normal in the right eye, whereas some fragmentations of interdigitation zone were still evident in the left eye.

CONCLUSION

We report a case of bilateral whiplash maculopathy from vitreoretinal traction subsequent to road traffic accident. After 1 year of follow-up, visual acuity was restored but paracentral scotoma persisted. Optical coherence tomography appearance of the left eye was still abnormal.

A Case of Traumatic Choroidopathy With Subretinal Fluid

Purpose:

We report a unique case of blunt ocular trauma with subretinal fluid (SRF), presumed to be traumatic choroidopathy as evidenced by multimodal imaging.

Methods:

A case report is presented.

Results:

A 22-year-old woman involved in a motor vehicle accident presented 1 day later to our emergency department with blurred vision in the left eye. Visual acuity was 20/40, significant SRF was present throughout the macula, and fluorescein angiography showed diffuse pooling and leakage. There were no retinal tears or intraocular inflammation. Indocyanine green angiography performed a week later showed patchy hypofluorescence in the affected area. One month later, visual acuity had improved to 20/20 and the SRF and the hypofluorescence on indocyanine green angiography had resolved.

Conclusions:

Subfoveal collection of SRF may be a cause of decreased vision following blunt ocular trauma. We hypothesize that in our case choroidal hypoperfusion and retinal pigment epithelial dysfunction contributed to the SRF collection.

Persistent pseudomyopia following a whiplash injury in a previously emmetropic woman

Purpose

Accommodative spasm, which manifests as ciliary muscle spasm, convergent strabismus or miosis, is a recognised consequence of head trauma. In whiplash cases, cervical spine hyperextension poses a risk of contra-coup injury and brainstem trauma, and is known to affect the visual system. However, to date, no cases of accommodative spasm due to whiplash injury have been reported.

Observations

We present the case of a 34-year-old female who developed sudden onset blurred distance vision after a rear impact car crash, having previously been emmetropic. Her unaided distance visual acuity was 20/70 in the right eye and 20/20 in the left. Best-corrected visual acuity in the right eye was 20/20 with a correction that progressed from −1.75 to −3.50 DS over the 12 months following the accident.

This patient's sudden unilateral myopia, with unilaterally increased amplitude of accommodation suggests pseudomyopia due to accommodative spasm. Magnetic resonance imaging showed no evidence of injury to her brain stem, frontal lobes or oculomotor nerve. The patient is now well adjusted with a −3.50DS corrective lens for the right eye.

Conclusions and importance

The accommodation reflex is susceptible to injury at the occipital lobe, frontal eye fields, Edinger-Westphal nuclei and oculomotor nerves. As such it should be examined in patients who present with visual disturbances following whiplash injury.

It is important that such cases are identified at presentation, as early intervention can improve outcomes in accommodative spasm and reduce the long term psychological effects often associated with whiplash injuries.

Acute Macular Neuroretinopathy Following Non-Ocular Trauma: A Hypothesis Regarding Pathophysiologic Mechanism

BACKGROUND AND OBJECTIVE

To describe the imaging characteristics and clinical course of acute macular neuroretinopathy (AMN) following non-ocular trauma, and to hypothesize a pathophysiologic mechanism for this syndrome.

PATIENTS AND METHODS

The records of five patients who developed symptoms and findings suggestive of AMN following trauma to the face or chest were retrospectively reviewed. Optical coherence tomography (OCT), infrared reflectance, fundus autofluorescence, fluorescein and indocyanine green angiography, and multifocal electroretinography were evaluated.

RESULTS

Visual symptoms started immediately or very soon after non-ocular trauma, and scotomas persisted at last follow-up (2 weeks to 10 years after trauma). OCT imaging performed within days of the trauma demonstrated focal areas of hyper-reflectivity in the outer plexiform and outer nuclear layers with eventual thinning of the outer nuclear layer, as well as variable loss of the ellipsoid and interdigitation zones.

CONCLUSION

Acute ischemic injury caused by trauma-induced hypotension and/or catecholamine release and involving the deep retinal capillary plexus is the pathogenic mechanism that most plausibly explains trauma-associated AMN.

Unusual bilateral traumatic maculopathy following whiplash injury

An unusual extensive bilateral macular oedema (MO) with spontaneous resolution occurred following a car crash accident. Qualitative and quantitative analysis of the macular region using spectral domain optical coherence tomography (SD-OCT) and multifocal electroretinogram (mfERG) was performed daily during the first 7 days, as well as at 3 and 6 months following the accident. SD-OCT examination demonstrated extensive MO accompanied by neurosensory detachment and subretinal fluid. During the 7 days following the accident there was gradual resolution of the oedema accompanied by visual recovery. One year later no anatomical changes were observed, the mfERG showed complete recovery and visual acuity returned to normal level. Although whiplash is a common injury in motor vehicle accidents, whiplash maculopathy (WMP) is rarely reported, most likely due to underdiagnosis. Here we describe the spontaneous resolution of a severe MO after whiplash injury in a car crash accident.

High-resolution optical coherence tomography findings in solar maculopathy and the differential diagnosis of outer retinal holes

PURPOSE

To characterize the morphology of outer retinal holes caused by solar maculopathy, using spectral-domain optical coherence tomography (SD-OCT).

DESIGN

This study is an observational case series.

METHODS

The SD-OCT findings of 3 patients (6 eyes) with chronic solar maculopathy are presented.

RESULTS

SD-OCT demonstrates a characteristic appearance of partial-thickness hole(s) in the outer retina at the fovea. In 3 of 6 eyes, there is 1 hole directly beneath the umbo. In the remaining 3 eyes, there are multifocal holes spread across the fovea. Holes in more restricted layers, as had been previously reported with time-domain OCT, were not seen. In addition, advanced visualization of SD-OCT data demonstrates a hyperreflective ring around the outer retinal hole.

CONCLUSIONS

SD-OCT can be used diagnose solar maculopathy. In patients with central scotomas, characteristic outer retinal hole(s) without inner retinal cystic changes may prompt the clinician to uncover an undisclosed history of sungazing. Similar OCT findings can be caused by welder's maculopathy, tamoxifen retinopathy, juxtafoveal macular telangiectasia, foveolar vitreomacular traction, or, rarely, a closed macular hole, achromatopsia, alkyl nitrite abuse, acute retinal pigment epitheliitis, or Stargardt disease.