eMedicine Specialties > Ophthalmology > Choroid

Choroidal Rupture: Follow-up

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Contributor Information and Disclosures

Updated: Jul 19, 2007

Follow-up

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.

Complications

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

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.
  • 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.
    • 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.3

Patient Education

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

Miscellaneous

Medicolegal Pitfalls

  • Choroidal neovascularization can reoccur, and periodic examinations are necessary.
 


More on Choroidal Rupture

Overview: Choroidal Rupture
Differential Diagnoses & Workup: Choroidal Rupture
Treatment & Medication: Choroidal Rupture
Follow-up: Choroidal Rupture
Multimedia: Choroidal Rupture
References
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References

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  2. White MF Jr, Morris R, Feist RM, et al. Eye injury: prevalence and prognosis by setting. South Med J. Feb 1989;82(2):151-8. [Medline].

  3. Gross JG, King LP, de Juan E Jr, Powers T. Subfoveal neovascular membrane removal in patients with traumatic choroidal rupture. Ophthalmology. Apr 1996;103(4):579-85. [Medline].

  4. Aguilar JP, Green WR. Choroidal rupture. A histopathologic study of 47 cases. Retina. Fall-Winter 1984;4(4):269-75. [Medline].

  5. Ament CS, Zacks DN, Lane AM, Krzystolik M, D'Amico DJ, Mukai S, et al. Predictors of visual outcome and choroidal neovascular membrane formation after traumatic choroidal rupture. Arch Ophthalmol. Jul 2006;124(7):957-66. [Medline].

  6. Bellows JG. Observations on 300 cases of ocular war injuries. Am J Ophthalmol. 1947;30:309-323.

  7. Conrath J, Forzano O, Ridings B. Photodynamic therapy for subfoveal CNV complicating traumatic choroidal rupture. Eye. Sep 2004;18(9):946-7. [Medline].

  8. Eagling EM. Ocular damage after blunt trauma to the eye. Its relationship to the nature of the injury. Br J Ophthalmol. Feb 1974;58(2):126-40. [Medline].

  9. Fuller B, Gitter KA. Traumatic choroidal rupture with late serous detachment of macula. Report of successful argon laser treatment. Arch Ophthalmol. Apr 1973;89(4):354-5. [Medline].

  10. Harissi-Dagher M, Sebag M, Gauthier D, Marcil G, Labelle P, Arbour JD. Photodynamic therapy in young patients with choroidal neovascularization following traumatic choroidal rupture. Am J Ophthalmol. Apr 2005;139(4):726-8. [Medline].

  11. Hart JC, Natsikos VE, Raistrick ER, Doran RM. Indirect choroidal tears at the posterior pole: a fluorescein angiographic and perimetric study. Br J Ophthalmol. Jan 1980;64(1):59-67. [Medline].

  12. Hilton GF. Late serosanguineous detachment of the macula after traumatic choroidal rupture. Am J Ophthalmol. Jun 1975;79(6):997-1000. [Medline].

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  16. Mennel S, Hausmann N, Meyer CH, Peter S. Photodynamic therapy and indocyanine green guided feeder vessel photocoagulation of choroidal neovascularization secondary to choroid rupture after blunt trauma. Graefes Arch Clin Exp Ophthalmol. Jan 2005;243(1):68-71. [Medline].

  17. Pearlstone AD. Delayed loss of central vision following multiple posterior segment trauma. Ann Ophthalmol. Apr 1980;12(4):409-11. [Medline].

  18. Secrétan M, Sickenberg M, Zografos L, Piguet B. Morphometric characteristics of traumatic choroidal ruptures associated with neovascularization. Retina. 1998;18(1):62-6. [Medline].

  19. Smith RE, Kelley JS, Harbin TS. Late macular complications of choroidal ruptures. Am J Ophthalmol. May 1974;77(5):650-8. [Medline].

  20. Von Graefe A. Zwei falle von ruptur der choroida. Graefes Arch Clin Exp Ophthalmol. 1854;1:402.

  21. Wood CM, Richardson J. Chorioretinal neovascular membranes complicating contusional eye injuries with indirect choroidal ruptures. Br J Ophthalmol. Feb 1990;74(2):93-6. [Medline].

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Further Reading

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Keywords

choroidal break, Bruch membrane, Bruch's membrane, retinal pigment epithelium, RPE, choroidal neovascularization, CNV

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Contributor Information and Disclosures

Author

Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, 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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Disclosure: Nothing to disclose.

Medical Editor

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, and American Society of Retina Specialists
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

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, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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