Choroidal Rupture Treatment & Management

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 16, 2009
 

Medical Care

During the healing phase of virtually all choroidal ruptures, CNV is present. CNV may be thought of as part of the wound healing response. Most cases of CNV involute spontaneously. In up to 30% of patients, CNV may arise again and cause visual loss.

Prior to the advent of anti-VEGF therapy, good management options for subfoveal CNV were not really available; therefore, a conservative approach was recommended for most choroidal ruptures.

In the current era of anti-VEGF therapy, the extraordinary results obtained in CNV secondary to age-related macular degeneration have been extrapolated to other causes of CNV with apparent good results.[3, 4]

Currently available anti-VEGF agents include bevacizumab, ranibizumab, and pegaptanib sodium (see Medication).

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Surgical Care

  • If CNV is extrafoveal, it may be treated successfully with laser photocoagulation. Recurrences seem few.[5]
  • Prior to the advent of anti-VEGF therapy, pars plana vitrectomy with membrane extraction was considered for subfoveal or juxtafoveal CNV.[6]
  • The role of photodynamic therapy with verteporfin is unclear; however, several case reports and case series using this treatment have shown encouraging results in these patients.
  • ICG-guided photocoagulation transiently closes feeder vessels of subfoveal CNV, but, eventually, these vessels become reperfused.
  • Currently, anti-VEGF therapy appears to have the most success.[4, 3]
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Consultations

Consult a vitreoretinal specialist.

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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, Pan-American Association of Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD  Retina Fellow, St Michael's Hospital, University of Toronto, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

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

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.

References

  1. Liggett PE, Pince KJ, Barlow W, Ragen M, Ryan SJ. Ocular trauma in an urban population. Review of 1132 cases. Ophthalmology. May 1990;97(5):581-4. [Medline].

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

  3. Yadav NK, Bharghav M, Vasudha K, Shetty KB. Choroidal neovascular membrane complicating traumatic choroidal rupture managed by intravitreal bevacizumab. Eye (Lond). Sep 2009;23(9):1872-3. [Medline].

  4. Chanana B, Azad RV, Kumar N. Intravitreal bevacizumab for subfoveal choroidal neovascularization secondary to traumatic choroidal rupture. Eye. Jan 23 2009;[Medline].

  5. 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].

  6. 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].

  7. Baath J, Ells AL, Kherani A, Williams RG. Severe retinal injuries from paintball projectiles. Can J Ophthalmol. Aug 2007;42(4):620-3. [Medline].

  8. Pahk PJ, Adelman RA. Ocular trauma resulting from paintball injury. Graefes Arch Clin Exp Ophthalmol. Apr 2009;247(4):469-75. [Medline].

  9. Ament CS, Zacks DN, Lane AM, et al. Predictors of visual outcome and choroidal neovascular membrane formation after traumatic choroidal rupture. Arch Ophthalmol. Jul 2006;124(7):957-66. [Medline].

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

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

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

  13. 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].

  14. 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].

  15. 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].

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

  17. Leys A, Dralands L, Missotten L. Late complications of choroidal ruptures. Bull Soc Belge Ophtalmol. 1981;193:137-41. [Medline].

  18. Luxenberg MN. Subretinal neovascularization associated with rupture of the choroid. Arch Ophthalmol. Aug 1986;104(8):1233. [Medline].

  19. Mehta HB, Shanmugam MP. Photodynamic therapy of a posttraumatic choroidal neovascular membrane. Indian J Ophthalmol. Jun 2005;53(2):131-2. [Medline].

  20. 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].

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

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

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

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

  25. 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].

  26. Wyszynski RE, Grossniklaus HE, Frank KE. Indirect choroidal rupture secondary to blunt ocular trauma. A review of eight eyes. Retina. 1988;8(4):237-43. [Medline].

 
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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 whowas 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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