OSLI Retina

May 2019

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May 2019 · Vol. 50, No. 5 309 ■ C A S E R E P O R T ■ Commotio Retinae Resulting From Rubber Band Injury in Two Girls Kanyakorn Wangsathaporn, MD; Irena Tsui, MD ABSTRACT: Commotio retinae is retinal opacifica- tion resulting from countercoup injury after blunt trauma. This case series describes two girls with commotio retinae following blunt ocular trauma after rubber band injuries. Optical coherence to- mography (OCT) showed defects in the outer reti- nal layers. OCT angiography showed no perfusion defects. OCT after 1-year follow-up revealed per- sistent outer retinal layer defects. This report em- phasizes the importance of preventing rubber band injuries. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:309-313.] INTRODUCTION Ocular trauma is a leading cause of acquired blind- ness in children. 1 The incidence of ocular trauma in children in the United States ranges from 8.85 to 15.2 in every 100,000 people. 2,3 Boys are at higher risk, and the increase varies from two to four times higher than girls. 4-8 The prognosis of an eye injury can range from mild symptoms to severe permanent vision loss, and 90% percent of eye injuries are preventable with protective eyewear. 9 We describe two 7-year-old girls with commotio retinae following rubber band injuries, including spectral-domain optical coherence tomography (SD- OCT) and findings at presentation and at 1-year fol- low-up. CASE STUDIES Case 1 A 7-year-old girl presented with decreased vision and pain in her left eye. Her 5-year-old brother had snapped an elastic exercise band that hit her eye. Right eye exam was normal. Best-corrected visual acuity (BCVA) in her left eye was 20/200. Anterior segment exam was remarkable for pigmented 1+ cell in her left eye. On dilated fundus examination, the left eye had commotio retinae in the macula and superotemporal periphery. There was also periph- eral retinal defects inferotemporally with intraretinal hemorrhages documented with ultra-widefield imag- ing (Optos, Marlborough, MA) (Figure 1A). SD-OCT (Spectralis; Heidelberg Engineering, Heidelberg, Ger- many) of the left eye had loss of reflection in the cone outer segment tips, inner segment-outer segment (IS/ OS) junction, and external limiting membrane (Figure 2A). OCT angiography (OCTA) (AngioVue; Optovue, Fremont, CA) was unremarkable (Figures 4A and 4B). The patient was treated with an encircling scleral buckle with cryopexy in her left eye. At 1-year fol- low-up, BCVA was 20/30 (wearing –4.50+1.00×010). Retina and macula were attached with scleral buckle, and cryopexy scar in the periphery (Figure 1B) SD- OCT revealed persistent outer retinal layer defects (Figures 2B and 2C). Case 2 A 7-year-old girl presented with decreased vi- sion, light sensitivity, and redness in her left eye. She was hit in her left eye with a rubber band by From the Department of Ophthalmology, Rajavithi hospital, Bangkok, Thailand (KW); Jules Stein Eye Institute, University of California Los Ange- les, Los Angeles (IT); and Doheny Eye Institute, University of California Los Angeles, Los Angeles (IT). Originally submitted April 21, 2018. Revision received April 21, 2018. Accepted for publication June 4, 2018. Presented at the Association of Pediatric Retina Specialists biannual meet- ing in Cabo San Lucas, Mexico, on March 31, 2018. The authors report no relevant financial disclosures. Address correspondence to Irena Tsui, MD, 200 Stein Plaza, Los Angeles, CA 90095; email: ITsui@jsei.ucla.edu. doi: 10.3928/23258160-20190503-08

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