J Korean Ophthalmol Soc.  2016 Dec;57(12):1970-1975. 10.3341/jkos.2016.57.12.1970.

A Case of Acute Macular Neuroretinopathy after Non-ocular Trauma

• Kim SE
• Lee SE
• Kim YY

• KMID: 2362718
• DOI: http://doi.org/10.3341/jkos.2016.57.12.1970

Abstract

PURPOSE
In the present study, an unusual case of traumatic retinopathy presenting as acute macular neuroretinopathy was reported.
CASE SUMMARY
A 69-year-old male was involved in a car accident and experienced a left 5th rib fracture. There was no direct ocular trauma. However, after the accident he noticed paracentral scotoma and loss of vision in his left eye. At initial examination 4 days after the trauma, central visual acuity was hand motion and visual field test revealed central scotoma in the left eye. Spectral domain optical coherence tomography showed hyper-reflectivity of the outer nuclear layer and disruption of the ellipsoid zone. Fluorescein angiography did not show any leakage or vascular damage but near-infrared autofluorescence imaging showed a dark lesion in the macular area. Visual acuity was improved to 0.2 at 2 weeks after trauma and 0.6 at 6 months after trauma while mild ellipsoid zone defect and visual field defect persisted.
CONCLUSIONS
Traumatic retinopathy presenting as acute macular neuroretinopathy is an uncommon disease causing paracentral scotomas after non-ocular trauma, and to the best of our knowledge, this is the first reported case in Korea.

Keyword

Acute macular neuroretinopathy; Central scotoma; Traumatic retinopathy

MeSH Terms

Aged
Fluorescein Angiography
Hand
Humans
Korea
Male
Optical Imaging
Rib Fractures
Scotoma
Tomography, Optical Coherence
Visual Acuity
Visual Field Tests
Visual Fields

Figure

• 

  Figure 1. Images of the left eye four days after car accident. Color fundus photography shows wedge-shaped brown discoloration (arrow) (A). The lesion (arrow) shows more clearly on red-free fundus photography (B). Spectral domain optical coherence tomography revealed hyper-reflectivity of the outer plexiform layer and outer nuclear layer and disruption of ellipsoid zone and interdigitation zone (arrows) (C).

• 

  Figure 2. Near-infrared autofluorescence image of the patient. Near-infrared imaging presents multiple hyporeflective darker lesions in left eye (A). The hyporeflective lesions (green lines) correlate to hyper-reflectivity in the outer nuclear layer and outer plexiform layer on spectral domain optical coherence tomography (B). A B

• 

  Figure 3. Humphrey visual field images of the patient. A Humphrey visual field study confirms paracentral scotoma in the left eye (A). There is no definite visual field defect 2 months after trauma (B).

• 

  Figure 4. Spectral domain optical coherence tomography images of the left eye 2 days and 6 months after trauma. The images display gradual improvement of the hyper-reflectivity within the outer plexiform layer and outer nuclear layer (ONL). But there are thinning of ONL and disruption of ellipsoid zone and interdigitation zone (between arrows).

Reference

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