Peripheral Retinal Hemorrhages - When it's not Ocular Ischemic Syndrome

Nova Southeastern University, Davie, Florida, USA

Introduction. Ocular Ischemic Syndrome (OIS) is usually the initial differential diagnosis when retinal hemorrhages are identified in the midperipheral or peripheral retina. The clinical presentation of OIS includes anterior and posterior segments findings, such as corneal edema, uveitis, hypotony, rubeosis and midperipheral dot and blot hemorrhages. Without anterior segment findings, a diagnosis of OIS is unlikely. Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is an uncommon, but symmetrical peripheral retinal degeneration that may vary in presentation from peripheral retinal pigment epithelial mottling, subretinal fluid or hemorrhage to vitreous hemorrhages. Case Report. A 79-year old white female presented with complaints of difficulty reading up close and seeing faces at intermediate and far distances. BVA was 4/16 OD, OS. DFE revealed macula geographic atrophy and isolated, midperipheral dot and blot hemorrhages OU. DFE of the periphery revealed a subretinal hemorrhage and scar due to a resolved subretinal hemorrhage OD and pre-retinal hemorrhage and scar due to a resolved subretinal hemorrhage OS. Discussion. Due to the overall clinical picture, we asked the patient to seek consultation with a retinologist for fluoresecein angiography (IVFA), optical coherence tomography (OCT) and to determine if treatment with anti-VEGF agents was deemed necessary. Conclusion. Despite the low prevalence (2,100 people affected each year), clinicians usually suspect OIS when they identify midperipheral and peripheral retinal hemorrhages. PEHCR is a rare, but symmetrical retinal degeneration that may present with isolated subretinal hemorrhages in the peripheral retina. Clinicians should be aware of this rare condition and its unique clinical presentation.