Sir,

We report a case of subfoveal choroidal neovascular membrane complicating traumatic choroidal rupture treated with intravitreal bevacizumab (Avastin). We are not aware of a similar, previous report.

Case report

A 30-year-old woman presented with a 3-week decrease in vision in OD. She had a history of blunt trauma to OD, 4 months back. Best-corrected visual acuity was counting finger 1 m OD and 6/6 OS. Fundus evaluation in OD showed juxtafoveal crescentic vertically oriented choroidal rupture with adjoining subretinal haemorrhage involving the fovea. Fluorescein angiography showed choroidal neovascular membrane (CNV) complicating choroidal rupture (Figure 1a). CNV complex with intraretinal oedema was seen on optical coherence tomography (OCT; Figure 2a). Central retinal thickness (CRT) was 420 μm. Patient was advised a photodynamic therapy and an intravitreal Avastin. Financial constraints made her opt for Avastin. It was administered after obtaining a written informed consent.

Figure 1
figure 1

(a) Pre-treatment angiogram shows staining of the choroidal rupture and pronounced leakage due to choroidal neovascular membrane. (b) A 6-month post-treatment angiogram shows the staining of choroidal rupture and scarred choroidal neovascular membrane.

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Figure 2
figure 2

(a) Pre-treatment optical coherence tomography shows CNV complex with intraretinal oedema. (b) A 6-month post-treatment optical coherence tomography shows resolution of the intraretinal fluid with a normal looking foveal contour.

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Patient received intravitreal Avastin 1.25 mg/0.05 ml. Because of the persistence of retinal oedema on OCT, at 6 weeks, repeat injection was given.

At 3-month post treatment, visual acuity had improved to 6/36. Fluorescein angiography documented angiographic closure of CNV (Figure 1b). CRT had reduced by 173 μm (Figure 2b). At 6 months, the findings were maintained.

Comments

Patients are at risk for the development of CNV months or years after their initial injury, because of damage to the Bruch's membrane.1 Secretan et al,2 retrospectively reviewed 79 eyes of 79 patients diagnosed with indirect choroidal rupture. Sixteen (20%) of the eyes developed CNV.

Laser photocoagulation, submacular surgeries, and photodynamic therapy alone or with intravitreal Avastin has been used for management of CNV in blunt and penetrating traumas.3, 4, 5 Majority of the post-traumatic membranes are subfoveal, thus ruling out laser photocoagulation as a treatment option. The result of submacular surgeries for choroidal neovascular membranes has been disappointing.3

In our patient, the CNV responded well over a 6-month period to the two injections of Avastin. The result suggests the use of intravitreal Avastin as monotherapy and merits further investigation for CNV complicating traumatic choroidal rupture.