A previously healthy, 12-year-old male presented for a routine visit with complaints of a 2-month history of decreased visual acuity in his left eye (LE). Six months before the visit, he suffered blunt trauma to the LE during a struggle, with no medical observation. At the initial visit, BCVA in the LE was counting fingers and in the right eye, it was 20/20. He had neither restricted eye movements nor afferent pupillary defects. Biomicroscopic examination of the anterior segment was normal. Fundus examination of the LE showed a central macular lesion of 1 disc diameter with fibrosis, increased retinal thickness and intraretinal hemorrhage (fig. , left). Peripheral retinal examination was normal. Spectralis OCT (Heidelberg Engineering Inc., Heidelberg, Germany) showed disruption of the IS/OS junction with corresponding increased reflectivity, loss of the outer nuclear layer, cell infiltration of the retinal wall and subretinal fibrosis. Retinal thickness was 289 µm at the site of the lesion (fig. , right). A fluorescein angiography (FA) revealed early impregnation with no diffusion, increasing with time (fig. ). With support from Pediatrics, off-label, high-steroid pulse therapy (intravenous methylprednisolone 500 mg for 3 days and oral prednisolone 30 mg, tapering for 10 days) was done, resulting in an increase of LE BCVA to 20/200 and a decrease of retinal thickness by 71 µm to 218 µm 1 week after treatment. In an attempt to achieve additional improvement without undesired systemic effects, off-label intravitreal triamcinolone acetonide (IVTA; 0.05 ml/2 mg) was administered 2 weeks after oral treatment. LE BCVA improved to 20/150, and retinal thickness decreased by 10 µm 3 weeks after IVTA. Three months after initial presentation, LE BCVA was 20/125 and retinal thickness was 208 µm. However, the alterations in fundoscopy and OCT remained (fig. ).
A 14-year-old boy presented immediately after injury to the left eye. Examination of the left eye showed a total hyphema which cleared in seven days and vision improved to 6/9. Fundus examination revealed whitish yellow curvilinear lesion and sub-retinal blood []. The right eye was normal.\nSSOCT done seven days post injury showed discontinuity in the RPE/BM complex [] in one area, and there was blood lifting the ellipsoid and ELM layers. The ellipsoid layer was intact over the area but appeared less defined and thicker compared to adjacent ellipsoid layer. The defect in RPE/BM complex was 195 μm. Except for the innermost layers of the choriocapillaries, the outer choriocapillaries and the outer two layers of the choroidal vasculature seemed to be intact. In another area with sub-retinal blood, there was a gap in the RPE/ BM complex measuring about 454 μm []. One edge of the defect was shadowed by the retinal blood vessel over the region.\nOCT done through the same area as in 6 weeks later showed that gap in the RPE/BM complex was bridged with hyper-reflective reparative tissue and this tissue had incorporated the ellipsoid layer, ELM, and part of the outer nuclear layer in it and disrupted them. Some tissue proliferation was seen at the choriocapillary level too [].