A 15-year-old girl presented with blurred vision after being hit by an elbow on her left eye. Her best-corrected visual acuity (BCVA) was 16/20. On fundus examination, both a choroidal rupture that formed a crescent shape concentric to the optic disc and a subretinal hemorrhage were detected (fig. ). 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. ).\nAfter 3 weeks, her visual acuity reduced to counting fingers. Fundus examination revealed that the subretinal hemorrhage had absorbed and the choroidal rupture had expanded. The crescent-shaped window defect including the fovea was observed on fluorescein angiography (FAG) (fig. ). Wider disrupted layers of the RPE, the IS/OS junction, and the ELM at the corresponding area were detected in OCT. 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. ).\nSteroid pulse therapy (methylprednisolone 500 mg intravenous for 3 days and prednisolone 30 mg oral, tapering for 11 days) was started in another hospital, and 3 months after the injury, visual acuity increased to 20/125. Five months later, OCT revealed that the size of the expanded choroidal rupture had reduced, and the adjacent retina had improved sufficiently to distinguish the IS/OS junction and the RPE. However, FAG disclosed a choroidal neovascular membrane originating from the nasal edge of the choroidal rupture (fig. , fig. ). 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. , fig. ). Also the IS/OS junction and the RPE had improved sufficiently and were able to be distinguished (fig. ).
A 13-year-old boy presented with 5 months old injury to the left eye. Examination of the left eye showed iris sphincter tears with angle recession. A curvilinear stellate yellowish gray lesion was seen just nasal to the fovea with associated gray-white lesion at the fovea []. The right eye was normal.\nSSOCT showed hyper-reflective, disorganized tissue involving RPE/BM complex, ellipsoid layer, external limiting membrane (ELM), and outer nuclear layer. This presumed scar tissue also involved the choriocapillary layer and the Sattler's layer. The Haller's layer was only minimally involved []. Scar tissue was also seen extending on the surface of the RPE away from the presumed site of rupture. The yellowish gray lesion seen at the posterior pole seemed to correspond to the areas where OCT showed the hyper-reflective scar tissue. No evidence of a full thickness BM or choroidal discontinuity could be made out.\nOCT angiogram (OCTA) showed the inner retinal capillaries to be intact. The outer retinal capillary layer showed some decreased vascular marking in the area of the scar. At the level of the photoreceptor and RPE, there was a discontinuity in the tissue pattern corresponding to the scar. Surrounding this discontinuity, there were new vessels. At the level of the choriocapillaries besides discontinuity in the vascular pattern due to scar tissue, there seemed to be increased vascularity along the rupture site itself [].