Traumatic Hyporeflective Micro-Elevations and Irregularity of the Ellipsoid Zone in Blunt Ocular Trauma

To investigate the prevalence, clinical course, and prognostic significance of hyporeflective micro-elevations and irregularity of the ellipsoid zone (MEEZ) in blunt ocular trauma.

Patients with blunt ocular trauma underwent standard ophthalmological examination and optical coherence tomography angiography. MEEZ was defined as small hyporeflective foci at the level of the ellipsoid and interdigitation zone, with disappearance of the thin hyporeflective band between these layers. The prevalence and spatial distribution of MEEZ, choriocapillaris perfusion, and associated findings were evaluated.

MEEZ was identified in 62 (40.3%) out of 154 eyes with blunt trauma, including nine eyes with MEEZ as the only form of posterior segment injury, and 53 eyes where MEEZ was found with other posterior segment injuries. Mean best-corrected visual acuity in eyes with MEEZ only was 0.0 logMAR (20/20 of Snellen equivalent). In eyes where MEEZ was associated with other posterior segment injuries, mean best-corrected visual acuity was 0.9 ± 0.64 logMAR (approximately 20/160 of Snellen equivalent). Choriocapillaris perfusion area in eyes with MEEZ only and healthy fellow eyes was 21.1 ± 1.3 and 20.4 ± 1.2 mm² (P > 0.05), respectively. During the follow-up, MEEZ showed complete resolution in all cases with available follow-up data (n = 15) after a median period of 34.0 days.

MEEZ is an important part of the spectrum of traumatic retinal changes frequently observed in blunt ocular trauma. As the only manifestation of blunt ocular trauma, MEEZ is associated with a favorable prognosis.