title: Optical coherence tomography morphologic grading of macular commotio retinae and its association with anatomic and visual outcomes.
abstract: OBJECTIVE
  To investigate the morphologic characteristics of macular commotio retinae using spectral-domain optical coherence tomography (SDOCT) and develop a grading system for traumatic photoreceptor damage.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  setting: Seoul National University Bundang Hospital. patients: Forty-nine patients with macular commotio retinae, examined by SDOCT within 7 days of the initial traumatic event. observations: A 4-step grading system was based on the morphology revealed by SDOCT. Best-corrected visual acuity (BCVA) and structural integrity of the 3 photoreceptor layers (cone outer segment tips [COST], inner/outer segment [IS-OS] junction, external limiting membrane [ELM]) were evaluated at baseline, at 1 month, and at the final visit. Visual and anatomic outcomes at 1 month and at the final visit were compared among subgroups. main outcome measures: The severity of photoreceptor damage as revealed by SDOCT and BCVA.
  
  
  RESULTS
  The following 4 distinct photoreceptor morphologic features were observed: increase in IS-OS junction reflectivity with the disappearance of the thin hyporeflective optical space (n = 8, grade 1), COST defect only (n = 5, grade 2), COST and IS-OS junction defects (n = 16, grade 3), and COST, IS-OS junction, and ELM defects (n = 20, grade 4). Eyes with higher grades at baseline had significantly worse visual (final BCVA, P = .002) and anatomic outcomes (complete photoreceptor recovery, P < .001).
  
  
  CONCLUSIONS
  The number of disrupted photoreceptor layers, as determined using SDOCT images, can be used to grade macular commotio retinae. This system may be useful in documenting the baseline severity of photoreceptor damage and in predicting visual and anatomic outcomes.
authors: Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors: Seong Joon
authors: SJ
authors: Ahn
authors: Se Joon
authors: SJ
authors: Woo
authors: Ko Eun
authors: KE
authors: Kim
authors: Dong Hyun
authors: DH
authors: Jo
authors: Jeeyun
authors: J
authors: Ahn
authors: Kyu Hyung
authors: KH
authors: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005131:Eye Injuries / Q000145:classification* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D012160:Retina / Q000293:injuries* / Q000503:physiopathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult