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Petalloid Foveal Hemorrhage in a Patient With High Myopia

Petalloid Foveal Hemorrhage in a Patient With High Myopia A 21-year-old man with myopic degeneration was examined because of asudden onset of decreased vision in his right eye. He denied recent traumaor Valsalva maneuver. His ocular history was significant for high myopia (OD,−14.00 diopters [D]; OS, −16.00 D) and cryotherapy in both eyesfor peripheral tears associated with lattice degeneration. On examination, visual acuity was 20/400 OD and 20/30 OS. Fundus examinationshowed tilted myopic discs with multiple lacquer cracks and irregular changesin the retinal pigment epithelium. A stellate intraretinal hemorrhage waspresent in the fovea of his right eye (Figure1). The hemorrhage was organized in a peculiar petalloid patternwith feathery distal edges, suggesting localization within the radially orientedHenle fiber layer. An optical coherence tomograph (Figure 2) showed areas of high backscattering and shadowing of theunderlying retinal pigment epithelium, consistent with hemorrhage in the intraretinalspace. Figure 1. View LargeDownload Fundus photograph showes petalloidfoveal hemorrhage in the patient's right eye. Figure 2. View LargeDownload Optical coherence tomograph demonstratesintraretinal location of heme. Fluorescein angiography showed a blocking defect corresponding to thehemorrhage. No late leakage was noted (Figure3). A late-phase indocyanine green angiogram also showed no choroidalleakage or neovascularization (Figure 4).At 12 months' follow-up, the foveal hemorrhage had resolved, leaving 20/50vision. A new lacquer crack was noted near the fovea, which may account forthe patient's decreased vision. Figure 3. View LargeDownload Midphase fluorescein angiogramshows no late leakage. Figure 4. View LargeDownload Late-phase indocyanine green angiogramshows no choroidal leakage or neovascularization. Comment Foveal hemorrhages in myopic eyes have been reported to form spontaneously,after accidental trauma, and after laser in situ keratomileusis.1,2 Subretinalhemorrhages have been reported to be the precursor of lacquer crack formation.3 The intraretinal location and symmetrical spreadinto the Henle fiber layer in our patient are unusual. This case vividly demonstratesthe anatomy of the fovea. Corresponding author: Richard Gary Lane, MD, Retina Service, WillsEye Hospital, 840 Walnut St, Suite 1020, Philadelphia, PA 19107 (e-mail: rglane@comcast.net). References 1. Hayasaka SUchida MSetogawa T Subretinal hemorrhages with or without choroidal neovascularizationin the maculas of patients with pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 1990;228277- 280PubMedGoogle ScholarCrossref 2. Ellies PPietrini DLumbroso LLebuisson DA Macular hemorrhage after laser in situ keratomileusis for high myopia. J Cataract Refract Surg. 2000;26922- 924PubMedGoogle ScholarCrossref 3. Ohno-Matsui KIto MTokoro T Subretinal bleeding without choroidal neovascularization in pathologicmyopia: a sign of new lacquer crack formation. Retina. 1996;16196- 202PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Petalloid Foveal Hemorrhage in a Patient With High Myopia

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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.122.4.660
Publisher site
See Article on Publisher Site

Abstract

A 21-year-old man with myopic degeneration was examined because of asudden onset of decreased vision in his right eye. He denied recent traumaor Valsalva maneuver. His ocular history was significant for high myopia (OD,−14.00 diopters [D]; OS, −16.00 D) and cryotherapy in both eyesfor peripheral tears associated with lattice degeneration. On examination, visual acuity was 20/400 OD and 20/30 OS. Fundus examinationshowed tilted myopic discs with multiple lacquer cracks and irregular changesin the retinal pigment epithelium. A stellate intraretinal hemorrhage waspresent in the fovea of his right eye (Figure1). The hemorrhage was organized in a peculiar petalloid patternwith feathery distal edges, suggesting localization within the radially orientedHenle fiber layer. An optical coherence tomograph (Figure 2) showed areas of high backscattering and shadowing of theunderlying retinal pigment epithelium, consistent with hemorrhage in the intraretinalspace. Figure 1. View LargeDownload Fundus photograph showes petalloidfoveal hemorrhage in the patient's right eye. Figure 2. View LargeDownload Optical coherence tomograph demonstratesintraretinal location of heme. Fluorescein angiography showed a blocking defect corresponding to thehemorrhage. No late leakage was noted (Figure3). A late-phase indocyanine green angiogram also showed no choroidalleakage or neovascularization (Figure 4).At 12 months' follow-up, the foveal hemorrhage had resolved, leaving 20/50vision. A new lacquer crack was noted near the fovea, which may account forthe patient's decreased vision. Figure 3. View LargeDownload Midphase fluorescein angiogramshows no late leakage. Figure 4. View LargeDownload Late-phase indocyanine green angiogramshows no choroidal leakage or neovascularization. Comment Foveal hemorrhages in myopic eyes have been reported to form spontaneously,after accidental trauma, and after laser in situ keratomileusis.1,2 Subretinalhemorrhages have been reported to be the precursor of lacquer crack formation.3 The intraretinal location and symmetrical spreadinto the Henle fiber layer in our patient are unusual. This case vividly demonstratesthe anatomy of the fovea. Corresponding author: Richard Gary Lane, MD, Retina Service, WillsEye Hospital, 840 Walnut St, Suite 1020, Philadelphia, PA 19107 (e-mail: rglane@comcast.net). References 1. Hayasaka SUchida MSetogawa T Subretinal hemorrhages with or without choroidal neovascularizationin the maculas of patients with pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 1990;228277- 280PubMedGoogle ScholarCrossref 2. Ellies PPietrini DLumbroso LLebuisson DA Macular hemorrhage after laser in situ keratomileusis for high myopia. J Cataract Refract Surg. 2000;26922- 924PubMedGoogle ScholarCrossref 3. Ohno-Matsui KIto MTokoro T Subretinal bleeding without choroidal neovascularization in pathologicmyopia: a sign of new lacquer crack formation. Retina. 1996;16196- 202PubMedGoogle ScholarCrossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Apr 1, 2004

Keywords: hemorrhage,myopia

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