A previously healthy, 19-year-old male presented for a visit in our department at 15–20 National Ophthalmology Institute with complaints of bilateral decreased visual acuity. He reported a blunt trauma on both eyes 8 days before due to resistance band (Fig. ) used for strengths exercises at home. He went through ophthalmological examination in another department the day of the trauma. At the visit, best-corrected visual acuity (BCVA) in right eye (RE) was 20/400 and 20/1,000 in the left eye. Slit-lamp examination did not show any scleral wound, corneal wound, or traumatism of the lens. Air-puffed intraocular pressure (IOP) was 14 mm Hg in the RE and 16 mm Hg in the left eye (LE). Air-puffed IOP device was used due to the risk of unknown scleral perforation in this traumatic context. Devices were cleaned with sanitizing spray after each examination, and a time-period of 15 min was respected between each patient examination in accordance with Hygiene Department guidelines. Fundus examination showed bilateral preretinal hemorrhages not allowing further examination. B-ultrasonography revealed no evidence of retinal tears or retinal detachment. No treatment has been started. The patient could not be referred initially to a reference center due to national lockdown while COVID-19 was spreading. One week later, BCVA was below 20/200 on RE and 20/1,000 on LE. IOP was 12 mm Hg on both eyes. Fundus examination after a 7-day delay recorded inferotemporal rupture of Bruch membrane on RE and inferior diffuse preretinal hemorrhages on both eyes. Fundus autofluorescence demonstrated increased autofluorescence in traumatic pigment epitheliopathy (Fig. ). Peripheral retinal examination was normal. Spectral-domain OCT (Heidelberg Engineering Inc., Heidelberg, Germany) showed bilateral increased reflectivity, disruption of the inner/OS (IS/OS), and loss of the external limiting membrane in the macular area (Fig. ). A full-thickness thin macular hole was present only on RE. Retinal thickness was decreased below 200 μm at the sites of the lesions. We decided to introduce oral steroids therapy 40 mg a day. The patient has been notified of the poor prognosis. The 6-week follow-up revealed a BCVA at 20/80 on RE and 20/63 on LE. The fundus examination showed a slight decrease of preretinal hemorrhages on both eyes. Spectral-domain OCT (Heidelberg Engineering Inc., Heidelberg, Germany) showed a spontaneous closure of macular hole on RE, and however, outer retinal layers remained atrophic on both eyes (Fig. ). No macular hole was present on left eye. The subject had given his written informed consent for publication of its case.
A 11-year-old boy presented with a 12-day old injury to the left eye. Examination revealed traumatic uveitis and mydriasis in the left eye. Fundus examination of the left eye showed a curved yellowish gray sub-retinal lesion at the macula involving the fovea []. Minimal sub-retinal bleed and a resolving vitreous hemorrhage were also noted. The right eye was normal.\nSSOCT scan done at presentation showed a break in the RPE/BM complex measuring 465 μm at the fovea. There was hyper reflective tissue extending from the outer nuclear layer of the retina to the choriocapillary layer. Ellipsoid and ELM layer could not be made out clearly [].\nTwo weeks later when the inflammation cleared, the vision improved to 6/18 from 6/60 in the left eye. Seven weeks after injury, the vision dropped to 6/36 and the SSOCT showed fibrous tissue invading all the neuro-retinal layers at the foveola []. In one area, fibrous tissue was seen extending into the vitreous cavity too []. There were a few cystic areas seen in the nuclear layers of the retina. OCTA showed normal inner and outer retinal layer vascularization. The tissue pattern at the level of the RPE was absent in the area of the rupture with no new vessels. At the level of the choriocapillaries, there were vessels in the scar tissue [].