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 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.