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Berlin’s oedema is a rare condition following blunt ocular injury and a rare finding after whiplash injury. This case describes a 48-year-old male who suffered a seventh vertebrae fracture from a traffic accident. Two days later, decreased left eye visual acuity and a positive Amsler grid test was reported. A preretinal paramacular haemorrhage was found on fundoscopy and ocular coherence tomography (OCT) revealed no fluid and a slight disruption in a number of retinal layers. At the one-year follow-up, the central scotoma had persisted despite a normal multifocal electroretinogram. OCT angiography (OCTA) revealed enlargement of the foveal avascular zone (FAZ) which has not been previously described in Berlin’s oedema. Previous authors hypothesised that the inner retina damage was responsible for FAZ enlargement. Retinal anoxia following retinal artery occlusion suggests vascular insults to the fovea influence oxygen supply and consumption within the inner retina. As oxygen consumption increases following occlusion and the choroid is unable to meet demand, it is possible the FAZ size would correspond to visual dysfunction as observed in diabetic retinopathy. The authors suggest FAZ enlargement in Berlin’s oedema may be a result of direct retinal injury with a similar mechanism of ischaemia seen in diabetic macular oedema. They emphasise that subtle OCT changes warrant OCTA examination. Furthermore, the authors recommend further research into post-traumatic maculopathies which would then help identify early candidates for visual rehabilitation as well as offer prognostic value.

Enlarged foveal avascular zone after whiplash injury – acquired Berlin’s edema.
Draca N, Cerovski B, Lazic R, et al.
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Annes Ahmeidat

MBChB, BSc, Ninewells Hospital and Medical School, Dundee, UK.

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