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Choroidal Rupture Follow-up

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 08, 2016
 

Further Outpatient Care

Most CNV occurs within the first year. However, CNV has been reported to occur as late as 35 years after the choroidal rupture.

Regularly scheduled examinations with fluorescein angiography (as circumstances dictate) are recommended during the first year.

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Deterrence/Prevention

In view of the high risk of sustaining a traumatic choroidal rupture, protective eyewear should be mandatory when participating in paintball.[10, 11]

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Complications

In 15-30% of patients, CNV may arise and lead to a hemorrhagic or serous macular detachment with concomitant visual loss.

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Prognosis

Most patients with choroidal ruptures do not reach a final visual acuity of 20/40 or better. Poor visual acuity is associated with macular rupture and poor baseline visual acuity.[12]

If the rupture does not involve the fovea, good vision is expected.

A hemorrhagic or serous macular detachment secondary to CNV may threaten visual function.

If CNV is extrafoveal, it may respond well to laser photocoagulation. Few recurrences are reported after laser photocoagulation.

Bevacizumab is a humanized recombinant monoclonal IgG antibody that binds and inhibits all VEGF isoforms. A few series have reported beneficial results following intravitreal bevacizumab.[4, 5]

If CNV is juxtafoveal or subfoveal, consider pars plana vitrectomy with membrane extraction. Gross et al reported good visual acuities in a small case series.[9]

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Patient Education

Teach patients to self-monitor each eye by using an Amsler grid and a near card.

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Contributor Information and Disclosures
Author

Lihteh Wu, MD Asociados de Macula Vitreo y Retina de Costa Rica

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical; Heidelberg Engineering.

Coauthor(s)

Dhariana Acón, MD Ophthalmologist, Caja Costarricense Seguro Social, Hospital de Guapiles, Costa Rica

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Russell P Jayne, MD Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists

Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.

References
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A 23-year-old man was in a motor vehicle accident 2 months before his presentation. His visual acuity is 20/400, and an afferent pupillary defect is present. Traumatic optic neuropathy and choroidal rupture are observed. This is a red-free photograph. (Courtesy of Jorge Gutierrez, MD.)
Mid-phase fluorescein angiogram in a 23-year-old man who was in a motor vehicle accident 2 months before his presentation. (Courtesy of Jorge Gutierrez, MD.)
Late-phase fluorescein angiogram in a 23-year-old who man was in a motor vehicle accident 2 months before his presentation. (Courtesy of Jorge Gutierrez, MD.)
 
 
 
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