PMC3764958_01
Fundus photography and FAG findings. a At the first medical examination, choroidal rupture at the macula, subretinal hemorrhage at the posterior pole, and commotio retinae on the temporal side of the retina. b After 3 weeks, expansion of the choroidal rupture site presents as a window defect including the fovea. c Hyperfluorescence from CNV at the nasal edge of the rupture site after 5 months. d Staining of the choroidal rupture and scarred CNV 1 month after an intravitreal bevacizumab injection.
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F1
On fundus examination, both a choroidal rupture that formed a crescent shape concentric to the optic disc and a subretinal hemorrhage were detected (fig. 1a). The crescent-shaped window defect including the fovea was observed on fluorescein angiography (FAG) (fig. 1b). However, FAG disclosed a choroidal neovascular membrane originating from the nasal edge of the choroidal rupture (fig. 1c, fig. 2d). An intravitreal bevacizumab (Avastin, 1.25 mg/0.05 ml; Genentech, Inc., San Francisco, Calif., USA) injection was administered, and 1 month later, the patient's BCVA of the left eye had improved to 20/32, and the CNV had shrunk (fig. 1d, fig. 2e).
OCT findings. a At the first medical examination, disruption of the retinal pigment epithelial layer with Bruch's membrane and distortion of the IS/OS junction and the ELM layer. b After 3 weeks, expansion of the choroidal rupture site and outer retinal changes (red arrowheads). c Vertical scan after 3 weeks, visible outer retinal changes (red arrowheads). d Newly developed CNV after 5 months. e Reduced CNV 1 month after an intravitreal bevacizumab injection. f Recovery of the expanded choroidal rupture site and the outer retina 1 month after an intravitreal bevacizumab injection.
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F2
Optical coherence tomography (OCT) showed that the juxtafoveal retinal pigment epithelial layer with Bruch's membrane was disrupted, and the inner segment/outer segment (IS/OS) of the photoreceptor junction and the external limiting membrane (ELM) layer were distorted with suspected pinpoint disruption (fig. 2a). When compared with the first medical examination after the injury, the IS/OS junction and the RPE adjacent to the ruptured site were hardly distinguishable, although they were originally clearly observed (fig. 2b, c). Also the IS/OS junction and the RPE had improved sufficiently and were able to be distinguished (fig. 2f).