Post-Traumatic Bruch’s Membrane Rupture: A Case Series Highlighting Imaging Features and Long-Term Complications

Abstract

Aims: To describe the clinical presentation, imaging features, and outcomes of post-traumatic Bruch’s membrane rupture (BMR), emphasizing the importance of long-term surveillance. Presentation of Case: We report three young male patients (ages 18, 24, and 26; mean ≈23 years) presenting with unilateral closed-globe contusive ocular trauma leading to BMR. Two cases were due to work-related high-velocity metallic impacts and one from blunt trauma by a tennis ball. Initial visual acuity (VA) in affected eyes was severely reduced to counting fingers at 1 meter, with normal vision (10/10) in fellow eyes. Fundus examination, optical coherence tomography (OCT), and fundus autofluorescence (FAF) revealed rupture lines, subretinal hemorrhage, and macular pseudo-hole formation (~581 µm in one case). Fluorescein angiography (FA) identified rupture-related window defects without leakage. Discussion: Multimodal imaging, particularly OCT and OCT-angiography (OCT-A), was essential for diagnosis and monitoring. Short-term complications included pseudo-macular hole formation and macular folds with transient hypotony and secondary ocular hypertension. All patients remain under long-term surveillance due to the risk of choroidal neovascularization (CNV). Conclusion: Post-traumatic BMR can cause significant visual impairment. Early recognition and long-term follow-up are crucial to detect complications and guide timely intervention.