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Progressive symmetric vertical macular wide angioid streak-like lacquer crack

Authors Mansour A

Received 23 December 2015

Accepted for publication 2 February 2016

Published 19 April 2016 Volume 2016:9 Pages 95—99


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Nitesh Kuhadiya

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Ahmad M Mansour1,2

1Department of Ophthalmology, American University of Beirut, 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon

Purpose: We report an unusual case of bilateral vertical lacquer crack with no history of ocular trauma and with progressive marked enlargement and consequent visual loss.
Methods: Three-year follow-up was completed using best-corrected visual acuity, serial fundus photographs, intravenous fluorescein angiography, and optical coherence tomography.
Results: We report the occurrence of lacquer crack in a 43-year-old woman with no history of trauma except for laser in situ keratomileusis surgery for mild myopia (as reported by the patient) in the past 5 years and habitual ocular rubbing. Lacquer crack started in the right eye and became evident 1 year later in the left eye. Serial photography after repeated intravitreal injections of ranibizumab for subfoveal choroidal new vessel showed the lacquer crack widened gradually in both eyes. Axial length measurement revealed the presence of high myopia. Best-corrected visual acuity dropped to 20/200 bilaterally.
Conclusion: We hypothesize that a thin Bruch's membrane in high myopia is prone for small rupture initially either spontaneously or following laser in situ keratomileusis and subsequent widening of the rupture by oculopression and intravitreal injections from rise in intraocular pressure.

Keywords: angioid streak, Bruch's membrane rupture, choroidal rupture, choroidal neovascularization, high myopia, lacquer crack, LASIK

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