TY - JOUR
T1 - Intrapapillary and Peripapillary Hemorrhage in Young Patients with Incomplete Posterior Vitreous Detachment
T2 - Signs of Vitreopapillary Traction
AU - Katz, Barrett
AU - Hoyt, William F.
N1 - Funding Information:
Originally received: May 2, 1994. Revision accepted: August 23, 1994. I Neuro-ophthalmology Unit, California Pacific Medical Center, San Francisco. 2 Departments of Ophthalmology and Neurological Surgery, School of Medicine, University of California, San Francisco. Supported in part by the Pacific Vision Foundation, San Francisco, California (Dr. Katz), and by an unrestricted grant from Research to Prevent Blindness, New York, New York (Dr. Katz). Reprint requests to Barrett Katz, MD, Neuro-ophthalmology Unit, California Pacific Medical Center, 2340 Clay St, San Francisco, CA 94115.
PY - 1995
Y1 - 1995
N2 - Purpose: The authors describe a benign condition characterized by intrapapillary and subretinal peripapillary hemorrhage, incomplete posterior vitreous detachment with persisting attachments to the disc, and preservation of optic nerve function in young patients. Methods: Eight patients 11 to 42 years of age with no or mild symptoms (blur, spot, or smudged were referred for disc hemorrhage; seven of these patients were Asian. All underwent complete ophthalmologic examination, including detailed slit-lamp microscopy; particular attention was paid to vitreous attachments. Results: Superficial hemorrhage occurred predominantly in the superior hemidisc and was often striking in appearance. Subretinal hemorrhage occurred at the superonasal disc margin in six patients and was centered inferonasally in two. Discs were generally small, mildly dysplastic, and tilted; all were mildly elevated. The posterior vitreous body was separated from the retina but remained attached to the disc. Six patients had subtle visual field abnormalities in the involved eye. The hemorrhages resolved without sequelae or impairment of vision. During a 6-month follow-up, no patient progressed to complete vitreous detachment, retinal tear, or retinal detachment or required surgery to release traction. Conclusion: The authors postulate that vitreopapillary traction traumatized disc vessels, causing hemorrhage in and around the disc. The superior hemidisc received the shearing force of detachment, which tore superficial vessels; transmission of the force through the retina caused subretinal bleeding. Posterior vitreous detachment remained incomplete because of tenacious vitreopapillary attachments. Mildly dysplastic discs, as in the young patients with myopia reported here, may have unusual vitreous attachments, predisposing them to the occurrence of and trauma from premature vitreous separation. The condition described is benign and requires no further evaluation or intervention.
AB - Purpose: The authors describe a benign condition characterized by intrapapillary and subretinal peripapillary hemorrhage, incomplete posterior vitreous detachment with persisting attachments to the disc, and preservation of optic nerve function in young patients. Methods: Eight patients 11 to 42 years of age with no or mild symptoms (blur, spot, or smudged were referred for disc hemorrhage; seven of these patients were Asian. All underwent complete ophthalmologic examination, including detailed slit-lamp microscopy; particular attention was paid to vitreous attachments. Results: Superficial hemorrhage occurred predominantly in the superior hemidisc and was often striking in appearance. Subretinal hemorrhage occurred at the superonasal disc margin in six patients and was centered inferonasally in two. Discs were generally small, mildly dysplastic, and tilted; all were mildly elevated. The posterior vitreous body was separated from the retina but remained attached to the disc. Six patients had subtle visual field abnormalities in the involved eye. The hemorrhages resolved without sequelae or impairment of vision. During a 6-month follow-up, no patient progressed to complete vitreous detachment, retinal tear, or retinal detachment or required surgery to release traction. Conclusion: The authors postulate that vitreopapillary traction traumatized disc vessels, causing hemorrhage in and around the disc. The superior hemidisc received the shearing force of detachment, which tore superficial vessels; transmission of the force through the retina caused subretinal bleeding. Posterior vitreous detachment remained incomplete because of tenacious vitreopapillary attachments. Mildly dysplastic discs, as in the young patients with myopia reported here, may have unusual vitreous attachments, predisposing them to the occurrence of and trauma from premature vitreous separation. The condition described is benign and requires no further evaluation or intervention.
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U2 - 10.1016/S0161-6420(95)31018-4
DO - 10.1016/S0161-6420(95)31018-4
M3 - Article
C2 - 7862424
AN - SCOPUS:0028893975
SN - 0161-6420
VL - 102
SP - 349
EP - 354
JO - Ophthalmology
JF - Ophthalmology
IS - 2
ER -