Using SD-OCT in the Assessment and Management of Commotio Retinae

Title Using SD-OCT in the Assessment and Management of Commotio Retinae
Author, Co-Author Richard Claiborne, Grace Tsan
Topic Treatment and Management of Posterior Sgmt Disease
Program Number
Ballroom A-B
Northwest Permanente - Kaiser Permanente

Background: Commotio retinae, also known as "Berlin edema," is a common finding following blunt ocular trauma, and may impair vision. SD-OCT has provided new insight into morphological retinal changes, and may predict visual outcome.

Case Report: a 52 yo HM was seen for an urgent exam following a car accident. He had blunt trauma to his left eye from airbag deployment. Ocular and medical histories were unremarkable. Entering acuities were 20/25 OD, and 20/40 OS. All ocular findings and imaging were unremarkable OD. However, anterior segment evaluation OS revealed edema and ecchymosis of the lids, large subconjunctival hemorrhage, and corneal abrasion. Posterior segment OS revealed a small flame hemorrhage superior to the optic nerve, and commotio retinae surrounding the macula and extending to the periphery. Baseline fundus photos were obtained with Optos. Macular SD-OCT imaging OS revealed reduced parafoveal retinal thickness with hyper-reflectivity of the photoreceptor layer. At 1-month follow-up, vision improved to 20/20 OD, 20/25 OS. All ocular conditions were fully resolved, and OCT imaging revealed normal reflectivity of the photoreceptor layer OU.

Discussion: Commotio retinae is characterized by gray-white discoloration of the retina, and was originally thought to be extracellular edema. However, SD-OCT reveals the pathogenesis is, in fact, related to photoreceptor damage, which can be categorized into 4 distinct grades. Grade 1 shows increase in the inner/outer segment (IS-OS) junction reflectivity; Grade 2 involves cone outer segment tips (COST) defect only; Grade 3 reveals COST and IS-OS junction defects; Grade 4 reveals COST, IS-OS, and ELM defects. Furthermore, higher grades have been associated with worse visual outcomes. In our case, the patient's findings were consistent with Grade 1 commotio retinae and his prognosis was good. Our observations support the utility of SD-OCT to assist with managing and educating patients with commotio retinae.

Affiliation of Co-Authors Northwest Permanente - Kaiser Permanente