title: Progressive symmetric vertical macular wide angioid streak-like lacquer crack.
abstract: OBJECTIVE
  We report an unusual case of bilateral vertical lacquer crack with no history of ocular trauma and with progressive marked enlargement and consequent visual loss.
  
  
  METHODS
  Three-year follow-up was completed using best-corrected visual acuity, serial fundus photographs, intravenous fluorescein angiography, and optical coherence tomography.
  
  
  RESULTS
  We report the occurrence of lacquer crack in a 43-year-old woman with no history of trauma except for laser in situ keratomileusis surgery for mild myopia (as reported by the patient) in the past 5 years and habitual ocular rubbing. Lacquer crack started in the right eye and became evident 1 year later in the left eye. Serial photography after repeated intravitreal injections of ranibizumab for subfoveal choroidal new vessel showed the lacquer crack widened gradually in both eyes. Axial length measurement revealed the presence of high myopia. Best-corrected visual acuity dropped to 20/200 bilaterally.
  
  
  CONCLUSIONS
  We hypothesize that a thin Bruch's membrane in high myopia is prone for small rupture initially either spontaneously or following laser in situ keratomileusis and subsequent widening of the rupture by oculopression and intravitreal injections from rise in intraocular pressure.
authors.affiliation: Department of Ophthalmology, American University of Beirut, Lebanon; Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Mansour
keywords: Bruch’s membrane rupture; LASIK; angioid streak; choroidal neovascularization; choroidal rupture; high myopia; lacquer crack