Unilateral Preretinal Hemorrhage in an Adolescent – Case Report
str. 103 – 107
Autorzy: Anna Wolnik 1 , Małgorzata Woś 1 , Jerzy Mackiewicz 2
1 Oddział Okulistyki z Pododdziałem Okulistyki Dziecięcej Szpitala Specjalistycznego im. Stefana Żeromskiego w Krakowie
Kierownik: dr n. med. Małgorzata Woś
2 Klinika Chirurgii Siatkówki i Ciała Szklistego Uniwersytetu Medycznego w Lublinie
Kierownik: dr hab. n. med. Jerzy Mackiewicz
Purpose: The purpose of this paper is to present a case of unilateral hemorrhage in the macular area in a 16-year-old patient. The paper also concentrates on the anatomical classification and nomenclature of premacular hemorrhages, their etiology and available treatment options.
Material and Methods: We performed a review of literature on the PubMed database to thoroughly search and collect all the reported cases using the key words: premacular hemorrhage, internal limiting membrane of the retina, sub-internal limiting membrane hemorrhage, sub-hyaloid hemorrhage.
A 16-year-old healthy boy was admitted to the Pediatric Ophthalmology Department due to decreased visual acuity in his left eye in the course of a massive unilateral hemorrhage in the macular area. A few days before symptoms appeared he had been exposed to a laser and high illuminance at the disco.
Results: Throughout hospitalization the spontaneous resolution of the hemorrhage was observed. Two months after the initial presentation best corrected visual acuity recovered to 0.9 and spectral-domain optical coherence tomography scans showed almost complete blood resorption. At four-month follow-up fundus of left eye demonstrated no sign of hemorrhage, spectral-domain optical coherence tomography confirmed total absorption of the blood with normalization of the foveal contour and best corrected visual acuity was 0.9.
Discussion: Clinical presentation of premacular hemorrhage does not provide unambiguous information about a precise localization of bleeding. This is particularly true when we want to know if blood appears sub-hyaloid or between the hyaloid and the sub-internal limiting membrane of retina. Precise origin of premacular hemorrhage, together with the determination of its size, patient age, visual acuity and possible presence of associated chronic diseases are crucial information for definition of the best management choice.
Conclusions: If spontaneous and significant blood resorption occurs, conservative management (observation) is appropriate. The case of our patient shows that, even in primarily massive bleeding, spontaneous resolution of hemorrhages may happen.