Serial Follow-up of Commotio Retinae Using Ultra-wide Field Imaging

Anna Lee; Seung Woo Hong; Ho Ra; Eun Chul Kim; Nam Yeo Kang; Jiwon Baek

doi:10.3341/jkos.2020.61.3.243

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Lee, Hong, Ra, Kim, Kang, and Baek: Serial Follow-up of Commotio Retinae Using Ultra-wide Field Imaging

Original Article

J Korean Ophthalmol Soc 2020;61(3):243-249.

Published online: 25 September 2020

DOI: https://doi.org/10.3341/jkos.2020.61.3.243

Serial Follow-up of Commotio Retinae Using Ultra-wide Field Imaging

Anna Lee, MD, Seung Woo Hong, MD, PhD, Ho Ra, MD, PhD, Eun Chul Kim, MD, PhD, Nam Yeo Kang, MD, PhD, Jiwon Baek, MD, PhD

Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea

Address reprint requests to Jiwon Baek, MD, PhD Department of Ophthalmology, Bucheon St. Mary's Hospital, #327 Sosa-ro, Bucheon 14647, Korea Tel: 82-32-340-2125, Fax: 82-32-340-2126 E-mail: md.jiwon@gmail.com

Received 25 April 2019 Revised 26 September 2019 Accepted 21 February 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To quantify the size of commotio retinae and investigate its spontaneous resolution over time using ultra-wide field (UWF) color fundus photography.

Methods

We analyzed serial UWF color fundus photographs of 33 eyes of 33 ocular trauma patients with commotio retinae. Total visible retinal areas and the areas of commotio retinae were measured at baseline, 3 days, 1 week, and 4 weeks from the initial traumatic event.

Results

The median time of observation was 10.8 ± 12.1 (4–44) weeks. Spontaneous resolution of commotio retinae was observed in all patients, and no patients experienced any complications during the follow-up period. The mean percentage of commotio retinae at 3 days significantly decreased compared to the baseline (8.51 ± 9.66% versus 12.23 ± 10.39%; p < 0.001), and more decreased at 1 week (1.04 ± 2.75%; p < 0.001), but no significant differences were observed between 1 week and 4 weeks (0.00 ± 0.00%; p = 0.219). The spontaneous resolution percentages during the first 3 days, between 3 days and 1 week, and during the next 4 weeks were 12.97 ± 13.44%/day, 19.62 ± 9.22%/day, and 0.87 ± 1.87%/day, respectively (p = 0.192 and p < 0.001, respectively). The resolution rate was higher during the first 1 week.

Conclusions

We quantified the size of commotio retinae using UWF color fundus photography. Most patients with commotio retinae resolved spontaneously during the first 1 week following trauma, and all cases completely resolved at 1 month without any complications.

Keywords: Commotio retinae, Ocular trauma, Ultra-wide field color fundus photography

References

1. Berlin R. On the so-called Commotio retinae. Klin Mbl Augenheilk. 1873; 11:42–78.

2. Sipperley JO, Quigley HA, Gass DM. Traumatic retinopathy in primates. The explanation of commotio retinae. Arch Ophthalmol. 1978; 96:2267–73.

3. Mansour AM, Green WR, Hogge C. Histopathology of commotio retinae. Retina. 1992; 12:24–8.

4. Sony P, Venkatesh P, Gadaginamath S, Garg SP. Optical coherence tomography findings in commotio retina. Clin Exp Ophthalmol. 2006; 34:621–3.

5. Hart J, Frank H. Retinal opacification after blunt non-perforating concussional injuries to the globe. A clinical and retinal fluorescein angiographic study. Trans Ophthalmol Soc U K. 1975; 95:94–100.

6. Oh J, Jung JH, Moon SW, et al. Commotio retinae with spectral-abdominal optical coherence tomography. Retina. 2011; 31:2044–9.

7. Ghasemi Falavarjani K, Wang K, Khadamy J, Sadda SR. Ultra-wide-field imaging in diabetic retinopathy; an overview. J Curr Ophthalmol. 2016; 28:57–60.

8. Witmer MT, Parlitsis G, Patel S, Kiss S. Comparison of abdominal-field fluorescein angiography with the Heidelberg Spectralis((R)) noncontact abdominalfield module versus the Optos((R)) Optomap((R)). Clin Ophthalmol. 2013; 7:389–94.

9. Hirano T, Imai A, Kasamatsu H, et al. Assessment of diabetic retinopathy using two abdominal-field fundus imaging systems, the Clarus(R) and Optos™ systems. BMC Ophthalmol. 2018; 18:332.

10. Tang M, Hui YN, Li YY, et al. Evaluation of traumatic retinopathy with abdominal field imaging under corneal scar or fixed small pupil. Int J Ophthalmol. 2018; 11:1371–6.

11. Kim DR, Hong EH, Shin YU, et al. Utility of abdominal fundus photography in patients with acute blunt ocular trauma. J Korean Ophthalmol Soc. 2019; 60:428–33.

12. Bunt-Milam AH, Black RA, Bensinger RE. Breakdown of the outer blood-retinal barrier in experimental commotio retinae. Exp Eye Res. 1986; 43:397–412.

13. Liem AT, Keunen JE, van Norren D. Reversible cone photo-receptor injury in commotio retinae of the macula. Retina. 1995; 15:58–61.

14. Itakura H, Kishi S. Restored photoreceptor outer segment in commotio retinae. Ophthalmic Surg Lasers Imaging. 2011; 42:Online:. e29–31.

15. Blanch RJ, Good PA, Shah P, et al. Visual outcomes after blunt abdominal trauma. Ophthalmology. 2013; 120:1588–91.

Figure 1.

Commotio retinae image analysis examples. The freehand tool in Image J was used to select the area of total visible retina, commotio retinae the yellow and blue line indicates the area of visible retinae, the commotio retinae, respectively. The percentage of commotio retinae was calculated by dividing the area of commotio retinae by the total visible retinal area and multiplying by 100.

Figure 2.

Serial follow up ultra-wide field (UWF) color fundus photography from the left eye of 15-year old female patient. 15-year old female patient presented with decreased vision in her left eye after eyeball injury by wood. She referred to us the day of the trauma. Cells were observed markedly in the anterior chamber by slit lamp examination. (A) Baseline UWF color fundus photography demonstrated a localized whitish opaque lesion at superior-temporal side. (B) At 3 days, the area of commotio retinae was decreased and (C) at 1 week the area of commotio retinae was showed more decrement but remained (D) After 4 weeks, UWF color fundus photography revealed absence of whitish lesion. The white dot lines on (A-C) indicate the area of commotion retinae.

Figure 3.

Number of patients with spontaneous resolution in relation to observation time. After 3 days from the traumatic event, 5 patients presented spontaneous resolution, while 27 patients showed spontaneos resolution at 1 week. One month later, all of them presented spontaneous resoltuion.

Figure 4.

Changes in area of commotio retina for individuals (%). Scatterplot showing the mean percentage of commotio retinae for 33 patients. Spontaneous resolution of commotio retinae was observed in all patients after 4 weeks and none of them had experienced any complication during follow-up.

Figure 5.

Relationsip between intensity, resolution rate and area of commotio retinae. Scatterplot (A) showing the velocity versus the intensity (r = −1.34, p < 0.457) and (B) showing the area versus intensity (r = 0.47, p = 0.795).

Table 1.

General characteristics in patients with commotio retinae

Characteristic	Patient
Male:female	27:6 (81.8:18.2)
Age (years)	26.3 ± 16.1 (6–58)
Follow-up periods (weeks)	10.8 ± 12.1 (4–44)
BCVA (logMAR)
Initial (median)	0.15 ± 0.27 (0–1.22)
Final (median)	0.02 ± 0.07 (0–0.30)
Abnormalities in ocular examination
Mild vitreous hemorrhage	5 (15.2)
Corneal laceration	1 (3.0)
Shallow retinal detachment	1 (3.0)
Retinal hemorrhage	1 (3.0)
Subretinal hemorrhage	2 (6.1)
Retinal tear	2 (6.1)
Blow-out fractures	3 (9.1)
Traumatic microhyphema	25 (75.8)

Values are presented as mean ± standard deviation or number (%).

BCVA = best-corrected visual acuity; logMAR = logarithm of minimal angle of resolution.

Table 2.

Causes of ocular trauma and location of commotion retinae

Causes of ocular trauma	Patient	Location of commotio retinae						Mean area (%)
Causes of ocular trauma	Patient	ST	IN	SN	IT	P	T	Mean area (%)
Ball	12 (36.4)	8 (24.2)	2 (6.1)	0	0	1 (3.0)	1 (3.0)	12.58 ± 10.62
Fistfight	4 (12.1)	0	0	1 (3.0)	2 (6.1)	1 (3.0)	0	21.70 ± 13.22
Foot	4 (12.1)	1 (3.0)	1 (3.0)	1 (3.0)	1 (3.0)	0	0	6.37 ± 6.43
Glasses	3 (9.1)	0	1 (3.0)	1 (3.0)	0	0	1 (3.0)	4.81 ± 2.81
Wood	4 (12.1)	2 (6.1)	1 (3.0)	0	0	1 (3.0)	0	9.55 ± 3.87
Metal	3 (9.1)	2 (6.1)	0	1 (3.0)	0	0	0	15.34 ± 14.40
Stone	1 (3.0)	0	0	0	0	1 (3.0)	0	28.16 ± 0.00
Rubber	1 (3.0)	0	0	0	1 (3.0)	0	0	1.47 ± 0.00
Wall	1 (3.0)	0	0	0	1 (3.0)	0	0	12.06 ± 0.00
Total	33	13 (39.4)	5 (15.2)	4 (12.1)	5 (15.2)	4 (12.1)	2 (6.1)	12.23 ± 10.39

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

ST = superotemporal; IN = inferonasal; SN = superonasal; IT = inferotemporal; P = posterior pole; T = temporal.

Table 3.

Repeated measures design for mean area of commotio retinae (%)

Follow-up period	Mean area (%)		p-value^*
Baseline	12.23 ± 10.39	<0.001^†	<0.001^‡	<0.001^§
3 days	8.51 ± 9.66	<0.001^†	<0.001^∏	<0.001^#
1 week	1.04 ± 2.75	<0.001^‡	<0.001^∏	0.219^¶
4 weeks	0.00 ± 0.00	<0.001^§	<0.001^#	0.219^¶

Values are presented as mean ± standard deviation.

^* Statistically significant p-value by repeated measures analysis of variance

^† comparison between baseline and 3 days

^‡ comparison between baseline and 1 week

^§ comparison between baseline and 4 weeks

^∏ comparison between 3 days and 1 week

^# comparison between 3 days and 4 weeks

^¶ comparison between 1 week and 4 weeks.

Table 4.

Repeated measures design for mean intensity of commotio retinae (%)

Follow-up period	Mean intensity (%)		p-value
Baseline	60.49 ± 2.22	<0.001^*†	<0.001^*‡	<0.001^*§
3 days	42.58 ± 4.42	<0.001^*†	<0.001^*∏	<0.001^*#
1 week	8.58 ± 3.30	<0.001^*‡	<0.001^*∏	0.084^¶
4 week	0.00 ± 0.00	<0.001^*§	<0.001^*#	0.084^¶

Values are presented as mean ± standard deviation.

^* Statistically significant p-value by repeated measures analysis of variance

^† comparison between baseline and 3 days

^‡ comparison between baseline and 1 week

^§ comparison between baseline and 4 weeks

^∏ comparison between 3 days and 1 week

^# comparison between 3 days and 4 weeks

^¶ comparison between 1 week and 4 weeks.

Table 5.

Initial mean area of commotio retinae % with respect to the resolution period

Group	Patient	Mean area (%)	p-value
1	5 (15.2)	6.66 ± 4.24	0.665^*	0.021^†‡
2	22 (66.7)	10.65 ± 9.51	0.665^*	0.023^†§
3	6 (18.2)	22.66 ± 11.16	0.021^†‡	0.023^†§

Values are presented as mean ± standard deviation or number (%).

‘Group 1’ presented spontaneous resolution group during the first 3 days. ‘Group 2’ presented spontaneous resolution group during one week. ‘Group 3’ presented spontaneous resolution group during one month.

^* Comparison between Group 1 and Group 2

^† statistically significant p-value by repeated measures ANOVA

^‡ comparison between Group 1 and Group 3

^§ comparison between Group 2 and Group 3.

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