Download Commotio Retinae and Spectral-Domain Optical Coherence

Commotio Retinae and Spectral-Domain Optical Coherence Tomography Associated Changes
Jessica Mai, O.D.
Nina Tran, O.D.
Michelle Matson, O.D.
VA Southern Nevada HCS
Abstract: A patient with acute blunt ocular trauma presents with commotio retinae at the macula.
Spectral-Domain Optical Coherence Tomography (SD-OCT) images document transient alterations of the
retinal layers from onset to gradual resolution of the condition.
I. Case History
 Patient demographics: 66 year old Asian male
 Chief complaint: blurred vision OS
 Ocular history
o Blunt trauma from a tree stump OS
 Medical history
o Diabetes mellitus
o Hypertension
o Hyperlipidemia
o Gastroesophageal reflux disease
o Prostate cancer
o Posttraumatic stress disorder
o Depression
 Medications
o Atorvastatin
o Citalopram
o Lisinopril
o Metformin
o Omeprazole
o Sildenafil
o Zolpidem
II. Pertinent Findings
 Clinical
o VA: OD 20/30, OS 20/80
o Conjunctival edema and subconjunctival hemorrhage OS
o Traumatic iritis OS
o Posterior vitreous detachment OS
o Commotio retinae at the macula OS
 Physical
o Left periorbital contusion
o Left upper eyelid laceration
 Other
o Macula SD-OCT: OCT demonstrates hyperreflective thickening of the inner segmentouter segment (IS/OS) junction immediately following trauma, which leads to the
development of irregular retinal pigment epithelial (RPE) and outer photoreceptor
segment layers with disruption of the IS/OS junction. Follow up images reveal the
eventual reappearance of the hyporeflective optical space and an improvement of visual
acuity OS to 20/20.
o Fundus photos: Serial photos document commotio retinae at the time of trauma and its
subsequent resolution.
o CT of head and face: Unremarkable, except for swelling overlying the left frontal bone.
III. Differential diagnosis
 Primary: commotio retinae
 Others : retinal detachment, branch retinal artery occlusion, white without pressure, myelinated
nerve fiber layer
IV. Diagnosis and discussion
 Commotio retinae resulting from blunt ocular trauma can be correlated to changes in the RPE
and photoreceptor layers as seen on SD-OCT imaging.
 Commotio retinae is a retinal opacity that develops opposite to the site of coup injury.
 Acute traumatic maculopathy with characteristic retinal opacification is referred to as Berlin’s
edema.
 Histological studies suggest retinal opacification is secondary to intracellular edema of the
Müller, RPE, nerve fiber, and photoreceptor cells. The major site of injury is likely at the junction
of the photoreceptor outer segment and RPE.
V. Treatment, management
 Commotio retinae is self-resolving and requires no treatment. Follow up should be in one to two
weeks to monitor for resolution.
 Gonioscopy should be done to rule out angle recession.
 IS/OS and RPE abnormalities are not observed in all cases; however, those with changes
demonstrate resolution on follow up images.
 Mild cases of commotio retinae show transient hyperreflectivity of the outer retina, which is
associated with good visual outcome.
 Traumatic iritis is managed with topical cycloplegics and topical corticosteroids.
 Bibliography
o Mansour AM, Green WR, Hogge C (1992). Histopathology of Commotio Retinae. Retina;
12(1):24-28.
o El Matri L, Chebil A, Kort F, Bouraoui R, Largueche L, Mghaieth F (2010). Optical
Coherence Tomographic Findings in Berlin’s Edema. J Ophthalmic Vis Res; 5(2):127-129.
o Park JY, Nam WH, Kim SH, Jang SY, Ohn YH, & Park TK (2011). Evaluation of the Central
Macula in Commotio Retinae Not Associated with Other Types of Traumatic
Retinopathy. Korean J Ophthalmol; 25(4):262-267.
o Souza-Santos F, Lavinsky D, Moraes NS, Castro AR, Cardillo JA, & Farah ME (2012).
Spectral-Domain Optical Coherence Tomography in Patients with Commotio Retinae.
Retina; 32(4):711-718.
VI. Conclusion
 Patients with commotio retinae should have documented fundus photos and macula OCT
imaging performed. Serial scans display a pattern of changes in the retinal layers that
correspond with the gradual resolution of commotio retinae.