The macula is the small, specialized area of the retina that gives us our straight-ahead reading and driving vision. Blunt eye trauma temporarily causes the round eye to stretch out like a football. This can stretch the macula and tear the orange eye wall, causing a choroidal rupture.
A choroidal rupture is a clinical diagnosis found during a dilated retinal examination. Immediately following the blunt injury, blood can hide the underlying rupture. Fluorescein angiography is often used to confirm the diagnosis and assess the severity of the retinal damage. Once the blood clears it is much easier to tell the extent of the macular damage. Central vision is usually good unless the rupture extends through the macular center.
New blood vessel growth beneath the macula (macular neovascularization, MNV) can develop in some patients with choroidal ruptures. These vessels cause the macula to swell with fluid and blood and often lead to permanent central vision loss. There are many causes of MNV including angioid streaks, degenerative myopia, idiopathic, ocular histoplasmosis, and age-related macular degeneration.
There is no specific treatment for the choroidal rupture, although MNV can be treated with Avastin, Lucentis, Eylea or Vabysmo. These drugs belong to a class of potent medications, VEGF inhibitors, that prevent MNV from growing and leaking. They have been extensively studied in patients with age-related macular degeneration, and are also highly effective in choroidal ruptures. Click here to learn more.
