First Author: S.Valsero Franco SPAIN
Co Author(s): J.A. Sanchez Aparicio S. Pinar Sueiro N. Martinez Alday 0 0 0 0 0 0 0 0 0
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To report the clinical features, treatment approach and outcome of a 36 year-old woman diagnosed of bilateral chorioretinitis sclopetaria as a result of an ocular injury caused by a bullet passing through bilateral maxillary bones.
31 year-old woman shot being two maxillary bones involved. After a few days, she noticed bilateral vision loss. After accurate examination, she was diagnosed of chorioretinitis sclopetaria and skull X-ray showed fractures of the floor of the orbits. Right one had been rebuilt in her origin country.
She arrived at Cruces Hospital 24 days after the accident. Initial visual acuity (VA) was 0,05 right eye and 0,2 left eye. Intraocular pressure (IOP) was 8 mmHg in both cases. Bilateral slit lamp examination revealed a normal anterior segment. Funduscopy indicated some ocular contusion injuries. In the right eye it appeared vitreous hemorrhage, superior retinal detachment, macular hole and a proliferation of fibrous tissue at the lower part in retina. In left eye, we observed preretinal and intraretinal hemorrhage with an association of an epirretinal membrane. No foreign bodies or signs of traumatic optic neuropathy were found. OCT showed bilateral macular hole at stage IV. Pars plana vitrectomy with retinal internal-limiting membrane peeling and facoemulsification with intraocular lens implantation were performed in both eyes at different days. At the end of the surgery silicone oil tamponade was administered in right eye and SF6 24% was inserted in left eye. In following revisions, OCT showed closure of the macular hole. We show evolution since 2009 to 2014.
As a result of the surgery, final best corrected Snellen visual acuity is 0,2/1,0 right/left eye, respectively. YAG laser capsulotomy was performed in her left eye. Bilateral slit lamp examination of anterior segment is stable. Retina remained attached in right eye thanks to silicone oil tamponade. Funduscopy showed a superior, stiff retina in right eye and an inferior, band fibrous in the left eye.
Sclopetaria although rare, causes profound visual loss. Accurate ophthalmic and orbital examination with ultrasonography and CT-Scan are mandatory. Macular hole is a common finding. It can be managed by observation. However, macular hole with progressive visual deteroration, can be managed with surgery , as our case ,with successful result. In spite of severe retinal and choroidal injuries, retinal detachment does not usually occur, due to scar formation. However, in our case, it represents one important cause of visual loss in the right eye.