Q. 1 – Which of the the following are true.
- The Bruch’s membrane is thicker than the retinal pigment epithelium
- The Bruchs membrane is considered and hypothesised to have a role in axial length increase
- The Bruchs membrane is a stretched firm membrane that does not develop folds.
- The Bruchs membrane opening is does not match the clinical margins of the optic disc in emmetropia.
Q. 2 – Which of the following are true and found in association with a choroidal tear following blunt trauma
- The anterior segment will always be normal
- There may be development of CNV.
- There is no loss of vision following a choroidal tear
- Choroidal tears are always associated with a retinal detachment.
Answer 1: 2
Answer: The Bruchs membrane is considered to have a role in axial length increase, it is hypothesised that axial elongation may be related to the production of BM in the retroequatorial region. While this still not proven. The Bruchs membrane is very thin and ranges between 2-5 microns, though some studies have found a slightly higher value. The Bruchs membrane can form folds, and these may be seen in patients with hypotonic maculopathy, when we call them choroidal folds, but they are actually Bruchs membrane folds. These may also be seen in other conditions and even after trauma. The Bruch’s membrane does generally match the clinical margins of the optic disc in emmtropia. It is specially in moderate and high myopia with increased axial length where due to the development of a Gamma zone there is a gap between the clinical optic disc margin and the Bruch’s membrane opening.
Answer 2: 2
The correct answer is 2. There is a very high possibility development of a CNVM in association with a choroidal tear. Initially there may be bleeding and this may be followed later with the development of a CNV. A choroidal tear specially when it involves at the macular and specially the fovea is associated with a significant decrease in vision. A choroidal tear is not always associated with a retinal detachment, however in view of the severity of blunt trauma, one must always examine the retinal periphery and make sure there are not trauma induced retinal tears which can lead to detachment. One may always examine the anterior segment for a deepening associated with angle recession, lens subluxation and development of a trauma induced cataract.