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Spontaneous, non-traumatic paediatric vitreous haemorrhage may occur secondary to a persistent hyaloid artery, which is easily diagnosed if visible on fundoscopy. We present two cases of

unexplained paediatric vitreous haemorrhage, referred to our tertiary clinic, in which optical coherence tomography angiography (OCT-A) was used to demonstrate flow through otherwise

clinically occult, hyaloid and peripapillary arterial remnants. OCT-A may prevent the need for extensive investigations in some cases paediatric vitreous haemorrhage, previously classified

as idiopathic. CASE 1 A 12-year-old female was referred with sudden loss of vision in her left eye to “perception of light”. Visual acuity in the right eye was 6/6 with correction. A fundus

obscuring vitreous haemorrhage was present. Dynamic B-scan ultrasound confirmed a flat retina with complete posterior vitreous detachment. Examination of the fellow eye was within normal

limits. There was no significant ocular or family history. The patient underwent a diagnostic and therapeutic vitrectomy. An underlying cause was not identified. Intraoperative fundus

fluorescein angiography of the fellow eye was normal. At post-operative review, her visual acuity was 6/7.5 OS with correction. OCT-A demonstrated an artery with flow signal in the left eye

extending into the vitreous cavity located 1.1 mm inferonasal to the centre of the optic (Fig. 1). The vitreous haemorrhage did not recur. CASE 2 A 6-month-old male infant of African

heritage presented at 46 weeks corrected gestational age on a background of prematurity (23 + 1 weeks), with a birth weight of 550 g. He previously underwent bilateral laser photocoagulation

for retinopathy of prematurity at 31 weeks postmenstrual age. He then developed a pre-retinal haemorrhage in the right eye. Examination under anaesthesia with conventional fluorescein

angiography demonstrated areas of temporal nonperfusion in both eyes; bilateral laser photocoagulation was performed. Avulsed retinal vessels were present in both eyes with regressed stage 3

disease, without plus disease. Complete resolution of the vitreous haemorrhage was noted one week post-operatively. OCT-A was subsequently performed, which revealed the presence of a

bilateral clinically occult persistent hyaloid artery (Fig. 2). DISCUSSION Spontaneous and traumatic paediatric vitreous haemorrhage secondary to persistent hyaloid artery remnants have been

well described [1, 2]. Here we demonstrate the presence of clinically occult, anomalous retinal arteries in two children presenting with vitreous or pre-retinal haemorrhages, with flow

signals demonstrated using OCT-A. A non-systematic review identified that approximately 1.7–6.5% of cases of spontaneous, unilateral paediatric vitreous haemorrhage are idiopathic [3]. It is

possible that clinically occult, persistent anomalous artery remnants may explain some of these cases. Whilst OCT-A may demonstrate flow in clinically obvious hyaloid arteries [4], we

recommend OCT-A of the optic disc for paediatric patients presenting with unexplained vitreous haemorrhage where media clarity permits. This may prevent the need for extensive

investigations, for example, to exclude underlying vasculitic, septic or haematological disorders [5]. Further studies are required to determine the prevalence of persistent hyaloid remnants

with proven flow signals using OCT-A in paediatric populations, and to further validate the possible association with vitreous haemorrhage. REFERENCES * Cekiç O, Totan Y, Batman C.

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CONTRIBUTIONS IHY: Conceptualisation, literature search, original draft, approval of the final manuscript. AI: Conceptualisation, original draft, approval of the final manuscript. RP:

Conceptualisation, original draft, approval of the final manuscript. SM: Conceptualisation, original draft, approval of the final manuscript. CKP: Conceptualisation, original draft,

supervision, approval of the final manuscript. FUNDING This work was funded by the Medical Research Council UK (IHY; MR/R000735/1). AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Nuffield

Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK Imran H. Yusuf & Chetan K. Patel * Oxford Eye Hospital, John

Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Imran H. Yusuf, Amanda Ie, Ravi Purohit & Chetan K. Patel * Stoke Mandeville Hospital, Buckinghamshire

Healthcare NHS Trust, Mandeville Road, Aylesbury, HP21 8AL, UK Sarah Maling Authors * Imran H. Yusuf View author publications You can also search for this author inPubMed Google Scholar *

Amanda Ie View author publications You can also search for this author inPubMed Google Scholar * Ravi Purohit View author publications You can also search for this author inPubMed Google

Scholar * Sarah Maling View author publications You can also search for this author inPubMed Google Scholar * Chetan K. Patel View author publications You can also search for this author

inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Chetan K. Patel. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION

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vitreous haemorrhage secondary to clinically occult, anomalous hyaloid and peripapillary arteries demonstrated by OCT-A. _Eye_ 36, 1842–1843 (2022).

https://doi.org/10.1038/s41433-021-01852-z Download citation * Received: 23 September 2021 * Revised: 13 October 2021 * Accepted: 09 November 2021 * Published: 17 February 2022 * Issue Date:

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