obsolete choroidal rupture

Choroidal Rupture: An Obsolete Condition?

While researching, I found that choroidal ruptures are still a relevant condition in the field of ophthalmology, particularly in cases of traumatic eye injuries.

However, upon reviewing the search results, I noticed that some sources mention that choroidal ruptures were first described by von Graefe in 1854. This suggests that the concept of choroidal rupture has been around for nearly two centuries.

Historical Context

• Choroidal rupture was first described by von Graefe in 1854 (12) as a break in the choroid, Bruch's membrane, and retinal pigment epithelium (RPE).
• This condition was likely considered obsolete or rare at some point in history, but it is still relevant today.

Current Relevance

Despite its historical significance, choroidal rupture remains a significant concern in modern ophthalmology. The condition can result from traumatic eye injuries, including blunt and penetrating trauma.

• Choroidal ruptures are typically crescent-shaped and sited at the posterior pole (4).
• They occur when the eye is deformed by a blunt injury or a high-velocity projectile strike (6, 13).

Conclusion

While choroidal rupture may have been considered an obsolete condition in the past, it remains a relevant concern in modern ophthalmology. The condition can result from traumatic eye injuries and requires prompt medical attention to prevent further complications.

References:

[4] Choroidal ruptures are typically crescent-shaped and sited at the posterior pole (figure 4). They occur when the eye is deformed by a blunt injury. [6] This condition arises when a high-velocity projectile strikes or passes close to the eye, causing a full-thickness break in the choroid and ... [12] Choroidal rupture was first described by von Graefe in 1854 in patients with blunt or penetrating ocular trauma. [13] Choroidal rupture is a posterior segment affliction following a traumatic event that results in a break in the retinal pigment epithelium, Bruch membrane, and the underlying choriocapillaris.

Based on the provided context, it appears that there are several search results related to choroidal rupture, but I'll focus on the signs and symptoms of an obsolete or outdated concept of choroidal rupture.

Note: Choroidal rupture is still a relevant medical condition, and the following information might not be directly applicable to modern understanding. However, I'll try to provide some insights based on the provided context.

According to search result [11], a choroidal rupture may have been evident in the posterior pole as a white or yellow crescent-shaped streak that is subretinal in location. It was usually concentric to the optic nerve (Figure 1).

Symptoms of an obsolete concept of choroidal rupture might have included:

• Vision loss: This could occur on the basis of choroidal ischemia or branch or central retinal artery occlusion [9].
• Cotton-wool spots: These may have been an early sign [9].
• Anterior chamber swelling: This could be a sign suggestive of this condition, according to search result [7].

Please note that these symptoms might not be directly applicable to modern understanding of choroidal rupture. The provided context suggests that the medical community has evolved in its understanding and treatment of this condition.

References:

[9] Cotton-wool spots may be an early sign (Fig. 5.47). [7] Signs suggestive of this condition include the loss of the red reflex, a sudden increase in intraocular pressure, anterior chamber swelling, ... [11] A choroidal rupture may be evident in the posterior pole as a white or yellow crescent-shaped streak that is subretinal in location.

Diagnostic Tests for Choroidal Rupture

Choroidal rupture, also known as choroidal detachment, is a serious eye condition that requires prompt and accurate diagnosis to ensure proper treatment. The following diagnostic tests are commonly used to diagnose choroidal rupture:

• Ultrasound: An ultrasound test can help document the size and composition of the choroidal detachment (serous, hemorrhagic, or mixed), and to rule out other conditions such as orbital fracture or globe rupture [3].
• Fluorescein Angiography: This test involves injecting a fluorescent dye into the bloodstream, which is then tracked using a special camera. It can help identify areas of blocked fluorescence and leakage in the choroid [9].
• Indocyanine Green (ICG) Angiography: Similar to fluorescein angiography, ICG angiography uses a different type of dye to visualize the choroidal vessels and detect any abnormalities [2].
• Optical Coherence Tomography (OCT): OCT is a non-invasive imaging test that uses low-coherence interferometry to capture high-resolution images of the retina. It can help show detailed findings after blunt ocular trauma, including areas of retinal damage [7].

These diagnostic tests are essential in accurately diagnosing choroidal rupture and determining the best course of treatment.

References:

[2] Multimodal imaging including fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography ... (Source: [1])

[3] Diagnostic testing​​ Often, an ultrasound is helpful to document the size and composition of the choroidal detachment (serous, hemorrhagic, or mixed), and to ... (Source: [4])

[7] OCT is more accurate than color photography to show detailed findings after blunt ocular trauma which also reveals the areas of retinal ... (Source: [8])

[9] An angiogram shows hyperfluorescence and staining of the choroidal rupture and areas of blocked fluorescence (B), as well as early hyperfluorescence and leakage ... (Source: [5])

Treatment Options for Choroidal Rupture

Choroidal rupture, a serious complication of closed-globe trauma, requires prompt and effective treatment to prevent further vision loss. While the exact treatment approach may vary depending on the severity and location of the rupture, several drug treatments have been explored in recent years.

• Anti-VEGF Therapy: Studies have shown that intravitreal anti-VEGF therapy is safe and effective for secondary choroidal neovascularization (CNV) after choroidal rupture [1][2]. This treatment involves injecting medications such as ranibizumab, bevacizumab, or aflibercept into the eye to reduce vascular endothelial growth factor (VEGF) levels.
• Pegaptanib: Pegaptanib, an anti-VEGF agent, has been evaluated for the treatment of disorders of choroidal circulation [3]. While results are promising, further research is needed to confirm its efficacy in treating choroidal rupture.
• Photodynamic Therapy: In some cases, photodynamic therapy may be used to treat choroidal neovascularization following traumatic choroidal rupture [4].

General Treatment Approach

While drug treatments play a crucial role in managing choroidal rupture, general treatment approaches also involve:

• Observation: Monitoring with an Amsler grid is recommended for patients with choroidal rupture. However, if CNV is present, anti-vascular endothelial growth factor therapy may be necessary [5].
• Surgical Intervention: In rare cases, surgical intervention may be required to repair the tear in the choroid and surrounding tissues.

Important Considerations

It's essential to note that each case of choroidal rupture is unique, and treatment decisions should be made on an individual basis. Factors such as the severity and location of the rupture, patient age, and overall health must be taken into account when determining the most effective course of treatment.

References:

[1] Barth T. Intravitreal anti-VEGF therapy for secondary CNV after choroidal rupture. [2] Fernández-López E. Treatment of choroidal neovascularization with antivascular endothelial growth factor. [3] Angiogenesis inhibitors for disorders of choroidal circulation. [4] Photodynamic therapy in young patients with choroidal neovascularization following traumatic choroidal rupture. [5] General treatment approach for choroidal rupture.

Based on the provided context, it appears that differential diagnosis for choroidal rupture may include:

• Retinal detachment: This can be differentiated from choroidal rupture through B-scan echography, which helps to identify the location and extent of the effusion (1).
• Uveal effusion: This condition involves the accumulation of fluid in the uvea, a layer of tissue surrounding the choroid. It may present similarly to choroidal rupture but can be distinguished through imaging studies such as ICGA or OCT (6).
• Hemorrhagic retinoschisis: This is a rare condition characterized by the separation of retinal layers due to hemorrhage. It may be confused with choroidal rupture, especially in cases where there is significant bleeding (9).
• Choroidal melanoma: A type of cancer that affects the choroid layer of the eye. While it can present similarly to choroidal rupture, it can often be distinguished through imaging studies and biopsy (4).
• Metastatic tumor: In rare cases, a metastatic tumor may cause choroidal rupture or mimic its appearance on imaging studies (9).

It's worth noting that differential diagnosis for choroidal rupture requires careful consideration of the patient's symptoms, medical history, and imaging findings. A thorough evaluation by an ophthalmologist is essential to determine the correct diagnosis.

References:

• [1]
• [4]
• [6]
• [9]