Self-limiting Bilateral Foveal Detachment after Coup-Contrecoup Injury
A 68-year-old man had sudden, painless, bilateral central blurred vision after an
automobile collision. He did not lose consciousness. Three hours later, visual acuity
was 20/150 in his right eye and 20/300 in his left eye. OCT showed bilateral subfoveal
and intraretinal fluid (
Fig A). One day later, intraretinal fluid had resolved with residual subfoveal fluid (
Fig B). The posterior hyaloid was broadly adherent, and the choriocapillaris appeared abnormally
hyperreflective (
Fig C). Two months later, the only OCT abnormality was irregularity of the ellipsoid zone
(
Fig D). Visual acuity recovered to 20/25 in both eyes. Acute, bilateral, self-limiting
foveal detachment after coup-contrecoup injury, sometimes referred to as “whiplash
maculopathy,” is a rare but likely under diagnosed condition. Possible mechanisms
include broad vitreomacular traction, transient choriocapillaris ischemia, or hyperacute
rise in endogenous corticosteroids leading to increased choroidal vascular permeability
(Magnified version of
Fig A-D is available online at
www.aaojournal.org/).
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