title: Outer retinal structure after closed-globe blunt ocular trauma.
abstract: OBJECTIVE
  To evaluate outer retinal structural abnormalities in patients with visual deficits after closed-globe blunt ocular trauma.
  
  
  METHODS
  Nine subjects with visual complaints after closed-globe blunt ocular trauma were examined between 1 month after trauma and 6 years after trauma. Spectral domain optical coherence tomography was used to assess the outer retinal architecture, whereas adaptive optics scanning light ophthalmoscopy was used to analyze the photoreceptor mosaic integrity.
  
  
  RESULTS
  Visual deficits ranged from central scotomas to decreased visual acuity. Spectral domain optical coherence tomography defects included focal foveal photoreceptor lesions, variable attenuation of the interdigitation zone, and mottling of the outer segment band, with one subject having normal outer retinal structure. Adaptive optics scanning light ophthalmoscopy revealed disruption of the photoreceptor mosaic in all subjects, variably manifesting as foveal focal discontinuities, perifoveal hyporeflective cones, and paracentral regions of selective cone loss.
  
  
  CONCLUSIONS
  We observe persistent outer retinal disruption in subjects with visual complaints after closed-globe blunt ocular trauma, albeit to a variable degree. Adaptive optics scanning light ophthalmoscopy imaging allows the assessment of photoreceptor structure at a level of detail not resolvable using spectral domain optical coherence tomography or other current clinical imaging tools. Multimodal imaging seems to be useful in revealing the cause of visual complaints in patients after closed-globe blunt ocular trauma. Future studies are needed to better understand how photoreceptor structure changes longitudinally in response to various traumas.
authors.affiliation: *Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin; †Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin; ‡Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York; §Icahn School of Medicine at Mount Sinai, New York, New York; ¶Retina Consultants Ltd, Des Plaines, Illinois; and Departments of **Biophysics, and ††Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: John A
authors.initials: JA
authors.lastname: Flatter
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cooper
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dubow
authors.forename: Alexander
authors.initials: A
authors.lastname: Pinhas
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Singh
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kapur
authors.forename: Nishit
authors.initials: N
authors.lastname: Shah
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Walsh
authors.forename: Sang H
authors.initials: SH
authors.lastname: Hong
authors.forename: David V
authors.initials: DV
authors.lastname: Weinberg
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Stepien
authors.forename: William J
authors.initials: WJ
authors.lastname: Wirostko
authors.forename: Scott
authors.initials: S
authors.lastname: Robison
authors.forename: Alfredo
authors.initials: A
authors.lastname: Dubra
authors.forename: Richard B
authors.initials: RB
authors.lastname: Rosen
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Connor
authors.forename: Joseph
authors.initials: J
authors.lastname: Carroll
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D005131:Eye Injuries / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology; D012160:Retina / Q000293:injuries* / Q000473:pathology; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000473:pathology; D014792:Visual Acuity / Q000502:physiology; D014949:Wounds, Nonpenetrating / Q000473:pathology*; D055815:Young Adult
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