Spontaneous subretinal pigment epithelium hemorrhage

Abstract

PurposeTo describe a case of spontaneous subretinal pigment epithelium hemorrhage in a high myopic patient.SettingSubretinal hemorrhage is an accumulation of blood between the neurosensory retina and the retinal pigment epithelium. Sub‐RPE (retinal pigment epithelium) hemorrhage is located between the RPE and Bruch's membrane.MethodsA 22 year old high myopic Brazilian man complained of acute blurred vision in his left eye over the past 2 days. The patient had no trauma and systemic pathology. Visual acuity in the right eye was 20/20 and in the left eye counting fingers (3 m). The intraocular pressure and biomicroscopy were normal. Fundus examinationof the right eye was normal. Fundus examination of the left eye showed a macular hemorrhage with well‐defined borders.ResultsThe patient underwent optical coherence tomography (OCT), fluorescein angiography (FA) and Indocyanine green (ICG) angiography. In the OCT was evident the sub‐RPE hemorrhage. Choroidal neovascularisation was not detected in any exam including ICG. No surgery was performed, only observation. At 30‐days follow‐up, the visual acuity in the left eye was 20/40. Fundus examinationshowed an absorption of the sub‐RPE hemorrhage.ConclusionsSubretinal hemorrhage may cause retinal damage through a number of mechanisms. Sub‐RPE hemorrhages have well‐defined borders attributed to the tight cell junctions among RPE cells. Good visual outcome is sometimes possible in selected patients with submacular hemorrhage managed without surgical intervention. The OCT is an important tool to localize the level of the hemorrhage. The recover of the visual acuity of the present case is probably due to the healthy retinal pigment epithelium and photoreceptors prior to the hemorrhage.