First Author: M.Vinkovic CROATIA
Co Author(s): G. DeSalvo M. Bradvica 0 0 0 0 0 0 0 0 0
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To report a case of preretinal hemorrhages maskerading as retinal cystic lesion in a patient with no history of ocular trauma or previous ocular inflammation.
Ophthalmology Department University Hospital Osijek, Osijek, Croatia
We report a 27.year-old female who presented with two weeks of blurred vision in the left eye. She underwent complete ophthalmic examination, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and B mode ultrasound (US). A detailed systemic workup was done to rule out possible infectious and inflammatory causes of the retinal lesions. Neurology referral was made to exclude neurologic causes for the loss of consciousness that she reported. No treatment was warranted because of the good visual acuity.
Fundoscopic examination revealed two globular, well-demarcated preretinal lesions at the posterior pole of the left eye. They appeared to be different in colour and size. OCT showed that the lesions were hyperreflective and contiguous with the retinal surface with a hint of the posterior hyaloid visible just anterior to their downslope. On FFA the lesions blocked the ﬂuorescence in all the angiogram phases. B mode US revealed pseudo-cystic lesions with hypoechogenic content. Systemic workup and neurologic examination were unremarkable. At two weeks follow up the lesions largely dissipated and their OCT showed persistent elevation of the inner limitant membrane (ILM) with a partially attached posterior hyaloid.
Preretinal/sub-ILM hemorrhages can be idiopathic or associated with Valsalva maneuvers, Terson syndrome, macroaneurysms, trauma, or blood dyscrasias. They can represent the first sign of a systemic disease and mimic parasitic cysts like in this case. We recommend a thorough investigation to rule out blood dyscrasia and infectious diseases especially when they are not presenting as isolated lesions.