A 10-year-old boy presented to a local doctor with a sudden decrease of vision and a central scotoma in the right eye two days after being hit in that eye with a wooden stick. A hemorrhage was found in the fundus at that time, so the patient was referred to our hospital, where a hemorrhage was observed in the fovea (). Corrected visual acuity was 20/70 and intraocular pressure was 12 mmHg OD. Optical coherence tomography scanning of the right eye showed submacular hemorrhage (). We performed paracentesis (0.3 mL) under general anesthesia to reduce the intraocular pressure. Next, we injected tPA (12.5 μg in 0.05 mL) into the vitreous cavity and waited 15 minutes for the hemorrhage to dissolve. We then performed a further paracentesis (0.1 mL), followed by injection of pure sulfur hexafluoride (SF6, 0.3 mL) into the vitreous cavity. After surgery, we instructed the patient to maintain a prone position as much as possible for a week. One day later, the hemorrhage had started to move out of the fovea, revealing a choroidal rupture beneath (). We considered this choroidal rupture to be the cause of the hemorrhage.\nThe macula was not damaged () and visual acuity improved to 20/16 by four months and 20/13 by seven months after the above treatment. The submacular hemorrhage had been successfully displaced out of the fovea. In spite of the remaining choroidal rupture, the patient has not complained of any symptoms, including metamorphopsia, after 3 years of follow-up.
A 7-year old boy presented 1 day after injury to the right eye. The left was normal. The right eye vision was 6/18. There were abrasions on the cornea. Anterior chamber had cells of 1+ and flare of 2+. Fundus examination showed a double humped sub-foveal bleed. The retina over the macula looked edematous clinically. OCT done at presentation showed blood between the RPE and ellipsoid layer. The ellipsoid and ELM layer over the blood lost its clear distinction and looked thickened due to edema. OCT line scan showed two areas of breaks in the RPE/BM complex measuring 103 and 185 μm [ pre]. One week later since the sub-macular blood persisted, he underwent pars plana vitrectomy, sub retinal tissue plasminogen activator injection, and SF6 gas replacement of the vitreous cavity using the technique described previously.[] A month later the vision improved to 6/9. The fundus picture and OCT line scan after surgery is shown in . Clinically macular area showed multiple stellate lines under the retina that did not correspond to areas of choroidal rupture. The ELM layer and ellipsoid layer were continuous under the foveola. There was scar tissue between the photoreceptor layer and RPE corresponding to the yellowish gray area under the fovea seen clinically. Full thickness neurosensory retinal defect was seen at the site of retinotomy. The RPE/BM complex break near the retinotomy was plugged with scar tissue. There were some cystic changes in the margin of the retinotomy site. At the site of the rupture corresponding to the area in pre, there was scarring and closure of the BM break like in the previous two cases [ post].\ngives an overview of the cases presented. As has been noted above besides a break in the BM, the SSOCT showed blood between RPE and ellipsoid layer, and variable amounts of edema of the inner retinal layers in all the three acute cases. The gap in the BM ranged from 103 to 465 μm. The inner neuro-sensory retina and the Sattler's and Haller's layers of the choroid did not show any disruption in the acute stage.\nOCT after a month of the injury showed scar tissue involving Sattler's layer, choriocapillary layer, BM, RPE, ellipsoid layer, ELM, and outer nuclear layer in all the cases.