Fluorescent angiography imaging of intravitreal active bleeding, due to deep venous thrombosis concomitant to Fournier gangrene

Abstract

To report a breakthrough bleeding in the vitreous cavity due to deep venous thrombosis, in a case of a middle-aged male patient who suffered concomitantly from Fournier's gangrene. Fluorescent angiography imaging displayed the intravitreal hemorrhage as occurring. We performed fundus fluorescein angiography and optical coherence tomography at baseline and follow-up examinations. During fluorescein angiography we identified, right eye fluorescent blockage corresponding to a pre-retinal, a subhyaloid, and an intraretinal hemorrhage in the posterior pole. Capillary non-perfusion, and capillary remodeling of the far temporal peripheral vasculature was detected as well, the left eye was unremarkable. A breakthrough bleeding in the vitreous cavity of the upper temporal vein branch was caught as it was happening. We did not observe leaking at the macula; our findings were confirmed with optical coherence tomography throughout the follow-up period. Active retinal bleeding has been reported only twice in the past, in these cases, it was attributed to superficial venous vessel rupture due to vitreous traction or Valsalva-like retinopathy at the site of neovascularization. Active retinal vein bleeding during a fluorescein angiography, secondary to deep venous thrombosis due to Fournier gangrene, has not been previously reported.