Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage☆
Received 15 January 2003; accepted 22 August 2003.
Abstract
Purpose
To describe the clinical features and to present results of new diagnostic methods to help define the cause of the clinical syndrome of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH).
Design
Retrospective review of patients with IHAPSH at presentation seen in 3 centers in Hawaii and Japan.
Methods
We analyzed data including patient demographics, presenting symptoms, initial and final visual acuities, biomicroscopic findings, fundus photographs, and results of available ancillary testing, including fluorescein angiography, B-scan ultrasonography, and optical coherence tomography.
Results
There were 10 eyes of 9 patients (7 female and 2 male, 8 Asian and 1 white) aged 14 to 79 years. All patients experienced an acute onset of visual symptoms. Eight eyes had mild to severe myopia (−2.50 diopters [D] to −9.50 D), and 8 eyes had a tilted disc. Hemorrhage within the disc and adjacent subretinal hemorrhage were located nasally in 6 eyes, superiorly in 2 eyes, and temporally in 2 eyes. Vitreous hemorrhage was noted in 6 of 10 eyes. Posterior vitreous evaluation by biomicroscopy (10 eyes), by B-scan ultrasonography (4 eyes), and by optical coherence tomography (2 eyes) revealed no evidence of vitreopapillary traction, except for a follow-up optical coherence tomography in 1 eye showing localized vitreoretinal separation with residual attachment to the optic disc 10 months after presentation. Fluorescein angiography showed mild disc staining in 4 of 8 eyes. Hemorrhage spontaneously resolved within 1 to 7 months, and there were no recurrent hemorrhages with an average follow-up of 13.5 months (range, 2–31 months). Visual acuities maintained or improved to 20/25 or better in 8 eyes. The other 2 eyes had unrelated poor vision.
Conclusions
Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage is more common in myopic eyes and spontaneously resolves without treatment. The unique structural architecture of the elevated nasal edge of the myopic tilted disc and the choroidal blood supply of the prelaminar optic nerve may predispose patients to bleeding from the optic discs, which may be spontaneous or may be precipitated by acute disc edema, Valsalva maneuver, or vitreopapillary traction.
1The Retina Center at Pali Momi, Kapiolani Medical Center at Pali Momi, Aiea, Hawaii, USA
2Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii, USA
3Department of Ophthalmology, Gunma University School of Medicine, Gunma, Japan
Reprint requests to Gregg T. Kokame, MD, The Retina Center at Pali Momi, 98-1079 Moanalua Road, Suite 470, Aiea, HI 96701, USA.
ABSTRACT