Traumatic myopia secondary to ciliary spasm after blunt eye trauma and reconsideration of its pathogenesis
The patient developed bilateral functional disturbance in the retina. Ophthalmoscopically no fundus abnormality was detected, but the swift work-up with mfERG and pattern reversal VEP revealed that the pathognomonic site was localized in the retina. Ocular ischemia, such as chorioretinal circulatory failure and ischemic optic neuropathy, has been reported to occur in association with pregnancy, delivery, and hemorrhagic shock following either injury or surgery. Although it has been reported that hypertension associated with toxemia of pregnancy can lead to retinal circulation disorders, it is conceivable that ocular ischemia induced by hemorrhagic shock was the main cause in this case because the symptoms were detected right at the end of the operation. The reversible visual fi eld disturbance, suggesting choroid circulation failure more than retinal circulation, but additional examinations such as indocyanine green angiography or electrooculography were needed for the differential diagnosis. Fundus angiography could not be performed; instead, we collected corroborative evidence by mfERG. Interestingly, the clinical fi ndings were similar to those of acute idiopathic blind spot enlargement (AIBSE) syndrome, except that the symptoms were secondary and bilateral, and the visual fi eld defects followed the retinal vascular arcade in part. This single case cannot be expanded to a general fi nding, but it may provide insight into a circulatory disturbance as one possible underlying pathology in some reported cases of AIBSE.