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Download PDF Brief Communication Open access Published: 17 February 2022 Paediatric vitreous haemorrhage secondary to clinically occult, anomalous hyaloid and peripapillary arteries

demonstrated by OCT-A Imran H. Yusuf  ORCID: orcid.org/0000-0002-0424-58521,2, Amanda Ie2, Ravi Purohit2, Sarah Maling3 & …Chetan K. Patel  ORCID: orcid.org/0000-0002-1409-60451,2 Show

authors Eye volume 36, pages 1842–1843 (2022)Cite this article

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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.

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.

A En-face infra-red image of the optic nerve head captured on Heidelberg Flex, with an overlay (red) showing flow anterior to the internal limiting membrane. B, C Vertical and horizontal

OCT-A cross-sections intersecting the area of flow in the vessel protruding into the vitreous.

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).

A En-face image of the optic nerve head using Optos imaging. No obvious anomaly was noted. B En-face infra-red image captured using Heidelberg Flex, with an OCT-A overlay showing the areas

where flow was identified, (illustrated in red). C, D Vertical and horizontal OCT-A cross sections (with reference to Fig. 2B) showing flow (yellow) in the hyaloid remnant.

imageDiscussion

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.

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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.

This work was funded by the Medical Research Council UK (IHY; MR/R000735/1).

Author informationAuthors 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

AuthorsImran H. YusufView author publications You can also search for this author inPubMed Google Scholar

Amanda IeView author publications You can also search for this author inPubMed Google Scholar

Ravi PurohitView author publications You can also search for this author inPubMed Google Scholar

Sarah MalingView author publications You can also search for this author inPubMed Google Scholar

Chetan K. PatelView author publications You can also search for this author inPubMed Google Scholar

Corresponding author Correspondence to Chetan K. Patel.

The authors declare no competing interests.

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About this articleCite this article Yusuf, I.H., Ie, A., Purohit, R. et al. Paediatric 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

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Received: 23 September 2021

Revised: 13 October 2021

Accepted: 09 November 2021

Published: 17 February 2022

Issue Date: September 2022

DOI: https://doi.org/10.1038/s41433-021-01852-z

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