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Sir, Blunt trauma like football injury may result in commotio retinae and traumatic macular hole.1, 2 Persistent visual impairment may occur in severe cases of commotio retinae due to damage to the photoreceptors or retinal pigment epithelia. We report the use of multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) in a patient with commotio retinae and traumatic macular hole following blunt ocular injury. To our knowledge, there has been no previous report in the literature on the mfERG findings following commotio retinae. In view of the small size of the traumatic macular hole, he was observed and surgery was not performed. At 6 weeks after the injury, the left eye visual acuity improved to 6/9. OCT demonstrated spontaneous closure of the macular hole (Figure 2a). At 18 months after the injury, his left eye vision recovered to 6/6 but he still complained of a relative scotoma at the inferiotemporal field. MfERG showed recovery of the retinal response density at the central macula due to closure of the macular hole (Figure 2b). However, the well-demarcated area of depressed retinal response in the superionasal macula persisted secondary to the damage associated with commotio retinae. Previous studies have utilised OCT imaging in documenting the natural progression and spontaneous closure of traumatic macular holes anatomically.2, 3, 4 However, the changes in retinal functions following traumatic macular hole could not be assessed using OCT. MfERG is an objective tool that has been used to evaluate retinal function in various macular disorders including idiopathic macular holes and X-linked juvenile retinoschisis.5, 6 The use of mfERG in our patient enabled us to demonstrate objectively the functional improvement after spontaneous closure of the traumatic macular hole as illustrated by the recovery of the retinal response amplitude at the central macula. Histological study of commotio retinae in primate models has demonstrated that disruption and degeneration of photoreceptor outer segments may occur after blunt ocular injury.7 As observed in our patient, the inferiotemporal visual field defect which persisted after the injury corresponded to the area of the commotio retinae. This was confirmed objectively by the well-demarcated reduction in retinal response density in the mfERG. The mfERG findings in our patient supported the suggestion that permanent visual loss following commotio retinae may occur due to permanent loss of photoreceptors. We believe that OCT and mfERG are valuable tools for assessing the anatomical alterations and functional changes of the retina, respectively, in patients after blunt ocular trauma.

Multifocal electroretinogram and optical coherence tomography of commotio retinae and traumatic macular hole