Optical coherence tomography classification of indirect choroidal ruptures: conclusive or misleading?

Abstract

Vishaal Bhambhwani, Shagun SoodGuru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, IndiaWe read with interest the article by Nair et al.1 We would like to make the following observations by analyzing a case of indirect choroidal rupture (ICR) which presented at our center, and which may question the authors’ theories.The authors state that there are two types of ruptures distinguishable on optical coherence tomography (OCT). The first type seen (type 1 ICR) was a forward protrusion of the retinal pigment epithelium-choriocapillaris (RPE-CC) layer with an acutely angled pyramid or dome shape. This was associated with either a small loss of continuity of the retinal pigment epithelium layer or elevated RPE-CC projection accompanied by a significant quantity of subretinal hemorrhage. The second type observed (type 2 ICR) was a larger area of disruption of the RPE-CC layer, photoreceptor inner segment/outer segment junction, and external limiting membrane, with a posteriorly directed concave contour depression at that area and downward sliding of tissues into the defect. There was no scenario in which the two types of ICR coexisted, either in the same rupture or in the same eye. Further, the authors hypothesize different mechanisms of injury for these two types and also state differences in the incidence of complications like the development of choroidal neovascularization. View original paper by Nair and colleagues.