Abstract
In this prospective study, we analysed the changes in retinal vessel density (VD) using optical coherence tomography angiography (OCTA) in patients with commotio retinae up to 6 months after blunt ocular trauma. We analysed the VD in the superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillary (RPC) and the foveal avascular zone (FAZ) area at 48 h, and 1, 3 and 6 months after the trauma and compared results with those of healthy fellow eyes. We also evaluated the best-corrected visual acuity (BCVA) and the structural, spectral domain (SD)-OCT parameters: ganglion cell complex (GCC) and retinal nerve fibre layer (RNFL). A total of 18 eyes of 18 patients (8 males, 10 females, mean age 49.61 ± 9.2 years) and 18 healthy control eyes were evaluated. GCC and RNFL thicknesses showed a significant trend towards progressively lower values from 1 month and 3 months after the trauma, respectively, compared to healthy eyes (p < 0.005). The reduction in SD-OCT parameters reached a plateau at 6 months. Similar behaviour was found in the VD of the SCP and RPC that significantly decreased, starting from 1 and 3 months after the trauma, respectively (p < 0.001). At 6 months, the VD values were stable. The DCP presented an initial decrease of VD (p < 0.001), and after 1 month, the values statistically increased until the sixth month, reaching values similar to those of the control group. The FAZ area and BCVA did not show statistically significant changes during the follow-up. OCTA provided a detailed and quantitative analysis of early retinal vascular perfusion alterations after commotio retinae, demonstrating that the impairment of the retinal microvasculature and its progressive changes over time occurred even in the absence of compromised visual acuity.
Highlights
Commotio retinae is a condition involving the outer retinal layers following closed globe trauma, characterised clinically by a transient opacity of the retina in the macula or mid-periphery, resulting in reduced vision that can be temporary or permanent [1]
The structural spectral domain (SD)-OCT examination showed no statistically significant differences in ganglion cell complex (GCC) parameters between the eyes evaluated at 48 h after trauma and the controls (p = 0.984)
At only 1 month after the commotio retinae, an initial significant reduction in GCC
Summary
Commotio retinae ( known as Berlin’s oedema) is a condition involving the outer retinal layers following closed globe trauma, characterised clinically by a transient opacity of the retina in the macula or mid-periphery, resulting in reduced vision that can be temporary or permanent [1] It is characterised by significant changes in the outer segments of the photoreceptors that can be restored during the follow-up period [2]. Structural spectral-domain optical coherence tomography (SD-OCT) has revealed the disruption of the photoreceptor layer and retinal pigment epithelium, showing a hyper-reflectivity of the ellipsoid layer [3,4] The appearance of this band was revealed to be temporary with a variable recovery that depends on the initial condition of disruption of the outer retinal layers. Previous studies have documented, using SD-OCT, the impairment of the ganglion cell complex (GCC) and the retinal nerve fibre layer (RNFL) after blunt ocular trauma, that while potentially reversible, demonstrates significant axonal damage [5,6,7]
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