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Predictors of Visual Outcome and Choroidal Neovascular Membrane Formation After Traumatic Choroidal Rupture
Christine Shortsleeve Ament, MD;
David N. Zacks, MD, PhD;
Anne Marie Lane, MPH;
Magdalena Krzystolik, MD;
Donald J. D’Amico, MD;
Shizuo Mukai, MD;
Lucy H. Young, MD, PhD;
John Loewenstein, MD;
Jorge Arroyo, MD;
Joan W. Miller, MD
Arch Ophthalmol. 2006;124:957-966.
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.
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.
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