Multimodal Imaging Characteristics and Presumed Cause of Intrapapillary Hemorrhage with Adjacent Peripapillary Subretinal Hemorrhage

PURPOSE: To describe the multimodal imaging findings of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) and reveal the possible mechanism of this rare benign disease. PATIENTS AND METHODS: Observational study. Three eyes in three patients with intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage were evaluated at the retina division of our institution. We describe the multimodal imaging findings including visual field examination, fundus photography, fluorescein and indocyanine green angiography (FFA&ICGA), spectral-domain optical coherence tomography (OCT), and ultrasonography. RESULTS: Three myopic patients with IHAPSH shared a similar clinical course and multimodal imaging appearance. The symptom was sudden dark shadows floating in the affected eye with mild visual blurring. Fundus photography showed hemorrhage in intrapapillary and subretinal, as well as optic disc bulges on the nasal side with local vitreoretinal separation in the affected eyes. OCT confirmed intrapapillary and subretinal hemorrhage with obviously elevated optic papilla in the affected eye and local vitreoretinal separation at the temporal side of optic disc together with vitreoretinal adhesion at the superonasal edge. FFA&ICGA ruled out optic drusen and neovascularization. B-ultrasonography in one case revealed optic disc bulge in the affected eye with tight traction by local detached vitreous posterior limiting membrane at the edge. The overall visual prognosis was excellent and the bleeding could be completely absorbed. CONCLUSION: IHAPSH tends to appear in young women with myopia. The mechanism may be attributed to an incomplete posterior vitreous detachment (PVD), followed by a tightly vitreous-papilla adhesion and concentrated traction to the superonasal part of the tilted small optic disc.