PMC6637433_01
Initial presentation and subsequent fundus photo and OCT 3 d post injury. . a) Left eye (OS) with nail in situ (bent from ricochet). b) OCT analysis (OS) 3 d post-injury: subretinal fluid. c) Fundus photo: large inferior central retina tear, vitreous hemorrhage and combined BRAO and BRVO 3 d post-injury (note pallor of the inferior retina). d) Fluorescein angiography: arterial-venous phase 3 d post-injury illustrating a lack of arterial perfusion (arrowhead: arteriole; arrow: venule). e) Retrograde venous filling in the late venous phase (arrowhead: arteriole shows no filling; arrow: venule shows retrograde flow)
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F1
A 23-year-old male presented to the emergency department following a work-related globe penetrating injury from a pneumatic nail gun to his left eye (OS) 4 mm inferionasally from the limbus (Figure 1a (Fig. 1)). Fundus examination demonstrated a posterior vitreous hemorrhage, 4 large semi-circular retinal holes at the 4:00, 5:00, 8:00 and 9:00 meridians between the ora serrata and the equator, each with a sub-retinal fluid (SFR) cuff as well as a large retinal hole (4 disc diameters) inferior to the optic nerve along the 6:00 meridian, two horseshoe retinal tears along the 12:00 meridian and extensive commotio in the inferior and inferotemporal retina (Figure 1b,c (Fig. 1)). Optical coherence tomography (OCT) demonstrated SRF in the macular region (Figure 1b (Fig. 1)) and fluorescein angiography demonstrated a BRAO and BRVO along the inferotemporal vascular arcade (Figure 1d,e (Fig. 1)) with no branch arterial filling and delayed branch venous filling by retrograde flow.
One-year follow-up demonstrates marked scaring of the inferior central retina. . a) Fundus photo (OS) 1 y post-injury: marked fibrosis of the inferior retina extending into the inferior macula with marked attenuation of the inferior temporal vascular arcade. b) Corresponding OCT: resolution of sub-retinal fluid and thickening of the inferior peri-macular area. c and d) Angiography 1 y post-injury: (c) extensive vascular attenuation in the inferior circulation compared to the time of the injury (d) - (arrow denotes same vessel).
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F2
Despite a good surgical outcome, BCVA 1 year after injury was 20/400 OS with scaring and atrophy evident in the inferior retina (Figure 2a,b (Fig. 2)). Extensive attenuation of the inferior vascular arcade was noted compared to the time of injury (Figure 2b,c (Fig. 2)).