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September's Case of The Month

This patient with previously stable involuted proliferative diabetic retinopathy (PDR) presented with some symptomatic superior field loss. A yellow and red subhyaloid hemorrhage was noted in the inferior macula. The more dependent red blood is hypoautofluorescent and the devitalized, more superior yellow blood is intensely hyperautofluorescent. Devitalized blood includes breakdown products of hemoglobin, including free bases (the heme porphyrin molecule without its iron ion). The free bases absorb blue light and thus appear yellow. The causative neovascularization is likely beneath the blood since angiography shows no leakage. On OCT, the yellow blood is hyperreflective throughout, and the red blood is hyperreflective on its surface and shadows more posteriorly. [This case can be found on www.retinarocks.org in the DR (Diabetic retinopathy) 08 PDR folder, DR PDR ILW-20200729]