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 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.