This 97YO male has a history of counting-finger vision in his left eye due to foveal macular atrophy. On 2/29/24, vision was 20/40 in his non-exudative right eye. He presented on 3/12/24 with sudden vision loss OD and new hand motions vision.
Optos color RGB imaging shows fairly dense central subretinal blood, with surrounding radiating blood in the deeper Henle’s layer (outer plexiform layer). Triton swept-source OCT shows variable thick subretinal blood and more inferior subretinal fluid. Henle’s blood is seen as a diffuse hyperreflective obscuration of the outer retinal layers. Vitrectomy with subretinal TPA was performed two days later. Two months later, vision was counting fingers, and the macula was completely free of fluid and blood.
Learning Points:
Radiating deep macular hemorrhages are seen in multiple conditions, including Valsalva and trauma. We have not previously seen these hemorrhages in neovascular AMD. Their unique radiating appearance results from blood accumulating in Henle’s layer. Kon Graversen et al described hemorrhagic unilateral retinopathy, an idiopathic disorder with a similar appearance (Retina 2014;34:483-489).
