POST-TRAUMATIC RUPTURE OF BRUCH'S MEMBRANE : A CASE REPORT

Ocular trauma is a major public health problem. All ocular structures can be damaged in case of a closed globe injury. These lesions, often multiple, can appear immediately or in a delayed manner. Choroidal rupture involves the choroid, Bruch's membrane, and the retinal pigment epithelium.

To report a case of post-traumatic rupture of Bruch's membrane through a medical observation.

A case of post traumatic rupture of bruch’s membrane in a 27 year old patient seen in our department 

This is a 27-year-old man with no previous pathological history who suffered a contusive trauma to the left eye by a punch following a fight one hour before his admission to the emergency room. 

The initial examination revealed a conscious patient in good general condition with significant palpebral edema and an inability to open the eyeball. The patient was treated with corticosteroids at a rate of 1mg/kg/d for 48 hours and was seen again after edema had subsided. Examination at 48 hours revealed hand movement visual acuity in the left eye, slight residual palpebral edema, an unremarkable anterior segment, and subretinal hemorrhage in the fundus with suspicion of Berlin edema in the macular region. The examination of the adelphic eye was unremarkable with a visual acuity of 10/10.  Fluorescein angiography showed pre-retinal and sub-retinal macular hemorrhages, a large area of ischemia in the macular area, and a spontaneous linear hypofluorescence in the sub-papillary and macular area. Optical coherence tomography of the left eye showed multiple ruptures of Bruch's membrane with the clear involvement of the foveolar depression. The patient was put on anti-inflammatory treatment: oral corticosteroid therapy 1mg/kg/d for 5 days and ketorolac-trometamol collyrium 1 drop 4 times a day for 21 days. The evolution was marked by the resorption of the hemorrhage with the persistence of the areas of ischemia and the rupture of Bruch's membrane. The patient is still followed up in consultation to date to watch for the occurrence of retinal neovessels.

Bruch's membrane rupture is a common complication of contusive ocular trauma. Monitoring should be continued for one year after the incident to detect secondary subretinal neovascularization. In addition to the emphasis on the prevention of ocular trauma, improvement in the management of ocular trauma requires better evaluation of the various treatments available to arrive at a less "empirical" and more appropriate approach.