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 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 [].