April 15, 2022
Authored by: Danielle Strauss, MD
CC: 63 yo man complains of new floaters in his right eye since the morning. Patient denied pain, described a curtain in the vision that floated.
PMHX: No past medical history
Past ocular history: Retinal tear in the left eye- s/p laser retinopexy years earlier
Va sc: 20/30 OD, 20/20 OS
IOP: 14 OD, 15 OS
1+ NS cataracts ou
DFE: see imaging below
Right eye widefield photo shows a new PVD in the right eye with associated vitreous hemorrhage.
When a patient presents with an acute hemorrhagic PVD, there is a 70% chance that an associated retinal tear is present. Therefore, a careful DFE must be performed.
The initial OPTOS widefield image above did not reveal any retinal tears. However, given the vitreous hemorrhage, we performed a careful scleral depressed DFE. Here is what we found:
Here is a close-up image of the horseshoe tear with a bridging retinal vessel that had bled, and caused the vitreous hemorrhage.
Luckily, the patient presented to us right away, before a retinal detachment could develop.
We proceeded with repairing the retinal tear immediately in the office with laser retinopexy. Below is an image of the retinal tear following the laser.
The patient was scheduled for close follow-up and will be seen in 1 week. Patients with acute hemorrhagic PVDs must be followed closely to monitor for the development of new tears, holes, bleeding, or retinal detachment.