Choroidal Rupture Workup

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

Imaging Studies

Because choroidal ruptures occur as a consequence of blunt ocular trauma, the ocular examination must be thorough to rule out orbital fractures or globe ruptures.

CT scanning/MRI

Consider CT scanning and MRI of the eye and orbit under appropriate circumstances.

Fluorescein angiography

Fluorescein angiography may be a useful adjunct to detect CNV.

If CNV is absent, hypofluorescence occurs during the early phase of the angiogram due to disruption of the choriocapillaris. During later stages, hyperfluorescence occurs from the adjacent healthy choriocapillaris.

If CNV is present, early hyperfluorescence followed by late leakage is present on the angiogram.

Angiography

Indocyanine green (ICG) angiography may be useful if subretinal blood blocks or hides CNV detection on a fluorescein angiogram.

Optical coherence tomography

With the advent of anti-VEGF therapy, optical coherence tomography (OCT) plays a major role in the management of CNV. Most clinicians consider the presence of fluid on the OCT scan as an indication of CNV activity and the need for further treatment.

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Histologic Findings

Direct choroidal ruptures are characterized by a complete absence of choroid and RPE. The overlying retina is intact but atrophic.

In indirect choroidal ruptures, CNV is a common finding during the early healing phases. Most CNV is in the subretinal space (Gass type 2). With time, most CNV involutes spontaneously. In a small number of cases, a disciform scar or fibrous tissue may grow into the retina and vitreous cavity.

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