Predictors of Visual Outcome and Choroidal Neovascular Membrane Formation After Traumatic Choroidal Rupture | Ophthalmology | JAMA Ophthalmology | JAMA Network
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Williams  DFMieler  WFWilliams  GA Posterior segment manifestations of ocular trauma.  Retina 1990;10 ((suppl 1)) S35- S44PubMedGoogle ScholarCrossref
Wood  CMRichardson  J Chorioretinal neovascular membranes complicating contusional eye injuries with indirect choroidal ruptures.  Br J Ophthalmol 1990;7493- 96PubMedGoogle ScholarCrossref
Wyszynski  REGrossniklaus  HEFrank  KE Indirect choroidal rupture secondary to blunt ocular trauma: a review of eight eyes.  Retina 1988;8237- 243PubMedGoogle ScholarCrossref
Hart  JCNatsikos  VERaistrick  ERDoran  RM Indirect choroidal tears at the posterior pole: a fluorescein angiographic and perimetric study.  Br J Ophthalmol 1980;6459- 67PubMedGoogle ScholarCrossref
Wu  L Choroidal rupture. May 3, 2001
Secretan  MSickenberg  MZografos  LPiguet  B Morphometric characteristics of traumatic choroidal ruptures associated with neovascularization.  Retina 1998;1862- 66PubMedGoogle ScholarCrossref
Bressler  SBBressler  NM Traumatic maculopathies. In:Shingleton  BHersh  PKenyon  Keds. Eye Trauma. Boston, Mass Mosby–Year Book Inc1998;190- 193Google Scholar
Macular Photocoagulation Study Group, Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: updated findings from two clinical trials.  Arch Ophthalmol 1993;1111200- 1209PubMedGoogle ScholarCrossref
Hilton  GF Late serosanguinous detachment of the macula after traumatic choroidal rupture  Am J Ophthalmol 1975;79997- 1000PubMedGoogle Scholar
De Laey  JJ Choroidal neovascularisation after traumatic choroidal rupture.  Bull Soc Belge Ophtalmol 1986;22053- 59PubMedGoogle Scholar
Leys  ADralands  LMissotten  L Late complications of choroidal ruptures.  Bull Soc Belge Ophtalmol 1981;193137- 141PubMedGoogle Scholar
Luxenberg  MN Subretinal neovascularization associated with rupture of the choroid.  Arch Ophthalmol 1986;1041233PubMedGoogle ScholarCrossref
Smith  REKelley  JSHarbin  TS Late macular complications of choroidal ruptures.  Am J Ophthalmol 1974;77650- 658PubMedGoogle Scholar
Pieramici  DJSternberg  PAaberg  TM  et al. Ocular Trauma Classification Group, A system for classifying mechanical injuries of the eye (globe).  Am J Ophthalmol 1997;123820- 831PubMedGoogle Scholar
Cox  D Regression models and life-tables.  J R Stat Soc Ser B 1972;34187- 200Google Scholar
Shen  WYLee  SYYeo  I  et al.  Predilection of the macular region to high incidence of choroidal neovascularization after intense laser photocoagulation in the monkey.  Arch Ophthalmol 2004;122353- 360PubMedGoogle ScholarCrossref
Friedman  E Choroidal neovascularization and age-related macular degeneration.  Ophthalmology 1999;106647- 660PubMedGoogle ScholarCrossref
Chandra  SRGragoudas  ESFriedman  E  et al.  Natural history of disciform degeneration of the macula.  Am J Ophthalmol 1974;78579- 582PubMedGoogle Scholar
Friedman  EKuwabara  T The retinal pigment epithelium, IV: the damaging effects of radiant energy.  Arch Ophthalmol 1968;80265- 279PubMedGoogle ScholarCrossref
Friedman  ETs'o  MO The retinal pigment epithelium, II: histologic changes associated with age.  Arch Ophthalmol 1968;79315- 320PubMedGoogle ScholarCrossref
Friedman  EKrupsky  SLane  AM  et al.  Ocular blood flow velocity in age-related macular degeneration.  Ophthalmology 1995;102640- 646PubMedGoogle ScholarCrossref
Friedman  EIvry  MEbert  E  et al.  Increased sclera rigidity and age-related macular degeneration.  Ophthalmology 1989;96104- 108PubMedGoogle ScholarCrossref
Gragoudas  ESChandra  SRFriedman  E  et al.  Disciform degeneration of the macula, II: pathogenesis.  Arch Ophthalmol 1976;94755- 757PubMedGoogle ScholarCrossref
Bressler  NM Submacular surgery: new information, more questions.  Arch Ophthalmol 1997;1151071- 1072PubMedGoogle ScholarCrossref
Gross  JGKing  LPde Juan  E  Jr  et al.  Subfoveal neovascular membrane removal in patients with traumatic choroidal rupture.  Ophthalmology 1996;103579- 585PubMedGoogle ScholarCrossref
Hawkins  BSBressler  NMBressler  SB  et al. Submacular Surgery Trials Research Group, Surgical removal vs observation for subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or idiopathic, I: ophthalmic findings from a randomized clinical trial: Submacular Surgery Trials (SST) Group H trial: SST report No. 9.  Arch Ophthalmol 2004;1221597- 1611PubMedGoogle ScholarCrossref
Treatment of Age-Related Macular Degeneration With Photodynamic Therapy Study Group, Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials: TAP report.  Arch Ophthalmol 1999;1171329- 1345PubMedGoogle ScholarCrossref
Ladas  IDGeorgalas  IRouvas  AA  et al.  Photodynamic therapy with verteporfin of choroidal neovascularization in angioid streaks: conventional vs early retreatment.  Eur J Ophthalmol 2005;1569- 73PubMedGoogle Scholar
Shah  GKBlinder  KJHariprasad  SM  et al.  Photodynamic therapy for juxtafoveal choroidal neovascularization due to ocular histoplasmosis syndrome.  Retina 2005;2526- 32PubMedGoogle ScholarCrossref
Liu  JCBoldt  HCFolk  JC  et al.  Photodynamic therapy of subfoveal and juxtafoveal choroidal neovascularization in ocular histoplasmosis syndrome: a retrospective case series.  Retina 2004;24863- 870PubMedGoogle ScholarCrossref
Harissi-Dagher  MSebag  MGauthier  D  et al.  Photodynamic therapy in young patients with choroidal neovascularization following traumatic choroidal rupture.  Am J Ophthalmol 2005;139726- 728PubMedGoogle ScholarCrossref
Clinical Sciences
July 2006

Predictors of Visual Outcome and Choroidal Neovascular Membrane Formation After Traumatic Choroidal Rupture

Author Affiliations

Author Affiliations: Retina Service (Drs Ament, Zacks, Krzystolik, D’Amico, Mukai, Young, Loewenstein, Arroyo, and Miller and Ms Lane) and Angiogenesis Laboratory (Drs Ament, Zacks, Krzystolik, D’Amico, and Miller), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston. Dr Zacks is now with the Retina Service, Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor.

Arch Ophthalmol. 2006;124(7):957-966. doi:10.1001/archopht.124.7.957

Objective  To determine predictors of choroidal neovascularization (CNV) and visual outcome after traumatic choroidal rupture.

Methods  A retrospective review of patients with traumatic choroidal rupture diagnosed in the Retina Service, Massachusetts Eye and Ear Infirmary, Boston, between January 1993 and August 2001 was performed. Parametric and nonparametric statistical methods were used to evaluate visual prognosis, CNV, and retinal detachment after traumatic choroidal rupture.

Results  One hundred eleven cases were identified and reviewed. Visual acuity (VA) changes were recorded in all of the cases. Thirty-eight (34%) of the 111 patients recovered driving vision (VA ≥20/40). Rupture location was recorded in 107 cases. Recovery of driving vision was seen in 20 (59%) of 34 eyes with peripheral choroidal ruptures, 17 (22%) of 73 eyes with macular choroidal ruptures, 38 (38%) of 99 eyes without CNV, 1 (8%) of 12 eyes with CNV, 38 (40%) of 96 eyes without retinal detachment, and 1 (7%) of 15 eyes with retinal detachment. Older age and location of rupture within the arcades were positively associated with CNV formation (P = .04 and .03, respectively). Foveal location of rupture, multiple ruptures, and poor baseline VA were associated with failure to recover driving vision in univariate regression analyses. In multivariate analysis, rupture location and baseline VA were independently associated with visual outcome. Of 12 patients diagnosed with CNV, 5 were not treated, 4 were treated with argon laser photocoagulation, 1 was treated with surgery, 1 was treated with argon laser photocoagulation followed by surgery, and 1 was treated with verteporfin photodynamic therapy.

Conclusions  Most patients with traumatic choroidal rupture do not achieve final VA of 20/40 or better. Poor visual outcome was most highly associated with a macular rupture and baseline VA of less than 20/40. The formation of CNV was most strongly associated with older age and macular choroidal rupture.