PDF(Pubmed)
Abstract：
BACKGROUND: Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage is commonly observed in myopia with tilted optic disc. It presents with typical features on the fundus and follows a self-limiting course. However, due to its complex etiology, clinicians sometimes lack sufficient understanding of it which can easily lead to misdiagnosis or overtreatment. In this case report, we describe a rare case of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage in both eyes.
METHODS: An 18-year-old female who has no past medical history experienced sudden black shadow blocking of her right eye in the right eye for the past 2 days after a 5-day history of COVID-19 infection. The best corrected visual acuity is 0.5 in the right eye and 0.6 in the left eye. Optical coherence tomography (OCT) showed tilted optic discs in both eyes, bulged nasal optic discs, and the presence of strong reflective material under the parafoveal retina of the optic discs. Fundus fluorescein angiography (FFA) showed subretinal fluorescence occlusion above and nasolateral to the optic disc in the right eye, with hypofluorescence below the optic disc; the subretinal below the optic disc was obscured by vitreous hemorrhage; hypofluorescence was seen in the optic disc region of the left eye.COVID-19 antigen was positive. The patient was in the early stage of the third COVID-19 infection when the disease occurred. We speculate that it may be related to it. After 5 months of conservative treatment, the patient\'s hemorrhage disappeared in both eyes and her best corrected visual acuity returned to normal.
CONCLUSIONS: Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage usually occurs in myopia with tilted optic disc. In most patients, the cause of the bleeding is unknown, but it can gradually resolve under clinical observation or conservative treatment.
METHODS: An 18-year-old female who has no past medical history experienced sudden black shadow blocking of her right eye in the right eye for the past 2 days after a 5-day history of COVID-19 infection. The best corrected visual acuity is 0.5 in the right eye and 0.6 in the left eye. Optical coherence tomography (OCT) showed tilted optic discs in both eyes, bulged nasal optic discs, and the presence of strong reflective material under the parafoveal retina of the optic discs. Fundus fluorescein angiography (FFA) showed subretinal fluorescence occlusion above and nasolateral to the optic disc in the right eye, with hypofluorescence below the optic disc; the subretinal below the optic disc was obscured by vitreous hemorrhage; hypofluorescence was seen in the optic disc region of the left eye.COVID-19 antigen was positive. The patient was in the early stage of the third COVID-19 infection when the disease occurred. We speculate that it may be related to it. After 5 months of conservative treatment, the patient\'s hemorrhage disappeared in both eyes and her best corrected visual acuity returned to normal.
CONCLUSIONS: Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage usually occurs in myopia with tilted optic disc. In most patients, the cause of the bleeding is unknown, but it can gradually resolve under clinical observation or conservative treatment.
摘要：
背景：在视盘倾斜的近视中，常见的是乳头内出血和邻近的乳头周围视网膜下出血。它具有眼底的典型特征，并遵循自我限制的过程。然而,由于其复杂的病因，临床医生有时对此缺乏足够的了解，这很容易导致误诊或过度治疗。在这个案例报告中,我们描述了一个罕见的乳头内出血和相邻的乳头周围视网膜下出血的双眼。
方法：一名没有既往病史的18岁女性在有COVID-19感染史5天后，右眼突然出现黑影遮挡。右眼的最佳矫正视力为0.5，左眼为0.6。光学相干断层扫描（OCT）显示双眼倾斜的视盘，凸出的鼻视盘，在视盘的旁凹视网膜下存在强反射物质。荧光素眼底血管造影（FFA）显示右眼视盘上方和鼻侧的视网膜下荧光阻塞，视盘下方荧光不足；视盘下方的视网膜下被玻璃体出血所掩盖；左眼视盘区域可见荧光不足。COVID-19抗原阳性。发病时，患者处于第三次COVID-19感染的早期阶段。我们推测可能与之有关。保守治疗5个月后,患者双眼出血消失，最佳矫正视力恢复正常。
结论：瞳孔内出血合并邻近的乳头周围视网膜下出血通常发生在视盘倾斜的近视中。在大多数患者中，出血的原因不明,但在临床观察或保守治疗下可逐渐消退。
方法：一名没有既往病史的18岁女性在有COVID-19感染史5天后，右眼突然出现黑影遮挡。右眼的最佳矫正视力为0.5，左眼为0.6。光学相干断层扫描（OCT）显示双眼倾斜的视盘，凸出的鼻视盘，在视盘的旁凹视网膜下存在强反射物质。荧光素眼底血管造影（FFA）显示右眼视盘上方和鼻侧的视网膜下荧光阻塞，视盘下方荧光不足；视盘下方的视网膜下被玻璃体出血所掩盖；左眼视盘区域可见荧光不足。COVID-19抗原阳性。发病时，患者处于第三次COVID-19感染的早期阶段。我们推测可能与之有关。保守治疗5个月后,患者双眼出血消失，最佳矫正视力恢复正常。
结论：瞳孔内出血合并邻近的乳头周围视网膜下出血通常发生在视盘倾斜的近视中。在大多数患者中，出血的原因不明,但在临床观察或保守治疗下可逐渐消退。
