This 33YO female noted decreased vision in her left eye immediately following blunt trauma when a ceiling an fell on her face. Vision was 20/20 in her normal OD and 20/125 OS.
Pseudocolor SLO imaging shows a vertical choroidal rupture bisecting the central macula with surrounding subretinal blood. Radiating retinal striae extend outwards from the rupture. There is a central hyperpigmented lesion centrally, which appears hyperreflective in the outer retina on OCT. There is a hyporeflective cystic space anterior to this lesion. The subretinal blood appears as a hyper- and hyporeflective band on OCT.
This case was submitted by Malvika Singh, Akansha Sharma and Manish Nagpal.
Learning Points:
An acute submacular hemorrhage following blunt trauma almost always indicates an underlying choroidal rupture as the source for the blood. The final vision is usually good unless the rupture extends through the macular center. These patients need to be followed long-term due to the increased risk for macular neovascularization (MNV).
The central pigmented lesion with overlying fluid was suggestive for a MNV. An anti-VEGF injection was given, but she was unfortunately immediately lost to follow up.
