The patient was a 53-year-old man in good health without any major illnesses. He claimed that in a recent car accident, which had occurred 3 days before he reported to the clinic, his right eye was hit by a suddenly inflating airbag. In addition to severe pain, he suffered from a sudden-onset loss of vision. Based on the patient's description, his car was involved in a full frontal collision with a roadside sign as he was making a left turn. He was not wearing his seatbelt and was driving at a speed of 50 km/h. The first clinical examination revealed that his right eye was not perceptive to light. The visual acuity of his left eye was 0.8. The intraocular pressure (IOP) of his right and left eye was 12 and 15 mm Hg, respectively. Slit lamp examination revealed that the anterior segment was largely normal and did not exhibit corneal or scleral laceration. Dilated fundus examination revealed that his right eye had massive subretinal hemorrhage around the optic disc with macular involvement in addition to vitreous hemorrhage, while his left eye was normal. Although the resolution was poor due to vitreous hemorrhage, optical coherence tomography (OCT) revealed a hint of macular edema with subretinal fluid with a central retinal thickness of 436 mum (Fig. 1). After a week of observation, the right eye still had no perception to light. Therefore, the patient was advised to have an intravitreal injection of 0.3 mL sulfur hexafluoride (SF6) in the right eye. The patient agreed, and the injection was administered with him in the prone position. Four days after the injection, vision in the right eye had improved. The patient could recognize hand motion within a distance of 60 cm. The IOP was 12 mm Hg. Dilated fundus examination revealed significantly reduced subretinal macular hemorrhage, which was pushed to the periphery of the retina. It was also observed that the location of the choroidal rupture was on the superior and the temporal side of the macula. OCT results suggested that the macular edema had significantly reduced, and the central retinal thickness had decreased to 278 mum, but it still contained some subretinal fluid. Since the intraocular gas had nearly disappeared, it was subsequently recommended that the patient receive a second intravitreal injection of 0.3 mL SF6 in the right eye. One week after the injection, visual acuity of the right eye had improved to 0.03, but the subretinal hemorrhage and the vitreous hemorrhage conditions had not improved at all (Fig. 2), while the central retinal thickness had slightly increased to 319 mum.
Since it was possible that a secondary choroidal neovascularization (CNV) had occurred, after fully informing the patient of the potential benefits and risks, we scheduled the patient for immediate intravitreal injection of 1.25 mg/0.05 mL bevacizumab in the right eye. Three weeks after the injection, the corrected visual acuity of the right eye had improved to 0.4, with only small amounts of residual subretinal hemorrhage at the superior, inferior, and nasal side of the eye. Vitreous hemorrhage had almost entirely disappeared as well. Fundus examination revealed a visible scar caused by the choroidal rupture. OCT results showed a complete absence of subretinal fluid, and the central retinal thickness had decreased to 210 mum. The location of the choroidal rupture was observed on fluorescein angiography, and dye leakage was not observed during the early or late phase (Fig. 3).