Predictors for choroidal neovascular membrane formation and visual outcome following blunt ocular trauma

The aim of this study was to determine the predictors for choroidal neovascular membrane formation and visual outcome after blunt ocular trauma.

Retrospective review of electronic medical records of patients with blunt ocular trauma from January 2013 to December 2016 at Narayana Nethralaya Super Speciality Eye Hospital (Bangalore, India) was done. Cases with positive macular findings were enrolled. Data such as age, sex, laterality, mode of injury, presenting and final vision, follow-up duration and retinal findings were noted.

A total of 853 cases were referred to the retina clinic with history of blunt ocular trauma. Of which, 37 cases with positive macular findings were identified. Trauma with ball (18/37, 49%) was the most common mode of injury. Choroidal rupture was seen in 33 (89%) eyes. Other retinal findings noted were as follows: retinal haemorrhages (11%), commotio retinae (22%), submacular haemorrhage (43%), macular hole (11%), epiretinal membrane (3%), macular scar (8%) and vitreous haemorrhage (4%). Choroidal neovascular membrane was noted in 6 (16%) out of 37 eyes. No retinal findings showed any positive association with choroidal neovascular membrane formation. Using Pearson's correlation test, independent variables such as presenting visual acuity (r = 0.601, p = 0.000) and choroidal neovascular membrane formation (r = -0.356, p = 0.031) showed a strong correlation with final visual acuity.

The occurrence rate of post-traumatic choroidal neovascular membranes is about 12% in eyes with choroidal rupture. Most choroidal neovascular membranes occur within 1 year of trauma. Eyes with poor presenting vision and choroidal rupture or subretinal haemorrhage warrant regular and shorter follow-up intervals for long periods to identify the choroidal neovascular membrane. Treatment with intravitreal anti-vascular endothelial growth factor therapy is useful.