A 48-year-old male obtained a whiplash neck injury and a fracture of the articulate processes of the 7th neck vertebrae from a traffic accident. Two days later, he reported blurred vision in the left eye (LE). Although the best corrected visual acuity (BCVA) was 20/25, Amsler grid test was positive. There was preretinal paramacular hemorrhage on fundus examination. OCT, OCTA, visual field (VF) examination, fluorescein angiography (FA), and multifocal electroretinogram (mfERG) were performed. To analyze foveal structure and thickness, we utilized a swept-source (SS)-OCT and OCTA system (Triton, Topcon, Tokyo, Japan). The central retinal thickness (CRT) was defined as the average thickness in the central circle area. For OCTA, 4.5 × 4.5 × 4.5 mm3 macular cubes were obtained. En face images of the retinal vasculature were created from the superficial capillary layer (SCL) and deep capillary layer (DCL), based on the automated layer segmentation. The FAZ area was defined as the area inside the central border of the capillary network and was manually delineated on the inner border using the standard software and then calculated automatically. VF was measured in macular program (M program, Octopus 900, Haag-Streit, USA) and mfERG and FA (Canon) were performed accordingly. OCT showed no fluid but a slight disruption of the outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelial (RPE) layer, and photoreceptors (PR) with hyper-reflectivity of the ellipsoid zone (EZ) and interdigitation zone (IZ) and remained unchanged throughout the 1-year follow-up (Fig. ). CRT was 241 and 257 μm for the LE and RE, respectively. VF showed fixed central scotoma (Fig. ). mfERG was unremarkable. FA revealed late paramacular hyperfluorescence in both eyes. OCTA showed an enlarged FAZ area in the SCL of 334,402 μm2 in the LE as compared to 253,521 μm2 in the RE, as well as in the DCL, measuring 814,944 μm2 in the LE as compared to 311,858 μm2 in the RE, respectively (Fig. ).
A 12-year-old girl presented with decreased vision in the right eye since 6 months following penetrating injury, for which primary repair was done elsewhere. Physical examination by Internist revealed OI. Best corrected visual acuity (BCVA) was 20/1000 in the right eye and 20/80 in the left eye. Refractive error was previously documented as –11 DS and –18 DS in the right and left eye, respectively. Examination revealed blue sclera in both eyes. Adherent leucoma with irregular anterior chamber and peripheral anterior synechiae were noted in right eye; fundus evaluation was not possible. Ultrasound was done and keratoplasty advised. Left eye fundus was unremarkable, except myopic appearance. However, she was lost to follow-up and presented again 3.5 years later with sudden diminution of vision in the left eye since 3 days.\nBCVA was 20/1000 in the right eye and 20/630 in the left. There were no additional findings on biomicroscopic examination in the right eye as compared to the initial visit. Fundus evaluation of the left eye showed the presence of a subfoveal choroidal neovascular membrane (CNVM) []. The clinical findings were confirmed on fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). FFA of the left eye revealed an active subfoveal classic CNVM with profuse leakage. Blocked choroidal fluorescence due to the overlying hemorrhage was also noted [Fig. and ]. OCT revealed subfoveal CNVM and sub-retinal fluid []. The treatment options were explained and informed consent was obtained. The patient was treated with intravitreal injections of Bevacizumab (1.25 mg/0.05 ml). At 1-month follow-up, the patient had a BCVA of 20/200 in the treated eye. Fundus evaluation showed a yellow-white linear streak deep to the retinal layers, suggestive of lacquer crack []. The patient received two re-treatments with intravitreal Bevacizumab at 1-month intervals, following which the CNV regressed. At the last follow-up, 6 months following the last injection, the fundus remained stable [] and visual acuity stabilized at 20/200.