Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Oct 19:2020:8858242.
doi: 10.1155/2020/8858242. eCollection 2020.

Vitreous Hemorrhage as Presenting Sign of Retinal Arteriovenous Malformation

Geraldine P B M Accou  1 , Fanny Nerinckx  1 , Bart P Leroy  2   3 , Julie De Zaeytijd  1
Affiliations
Case Reports

Vitreous Hemorrhage as Presenting Sign of Retinal Arteriovenous Malformation

Geraldine P B M Accou et al. Case Rep Ophthalmol Med. .

Abstract

Objective: To describe a patient with vitreous hemorrhage and peripheral retinal ischemia, eventually diagnosed with an underlying retinal arteriovenous malformation.

Methods: A 15-year-old girl presented with sudden-onset, painless visual loss in the right eye. She underwent a full ophthalmological work-up.

Results: BCVA was less than 20/400 in the right eye and 20/20 in the left eye. Intraocular pressure and anterior segment examination were unremarkable. Fundoscopy was impossible due to an opaque vitreous hemorrhage in the right eye. The left eye was completely unremarkable. Examination during a 23-gauge pars plana vitrectomy showed dilated, tortuous arteriovenous vessels extending from the optic disc and silver wiring of the enlarged vessels. A clinical diagnosis of retinal arteriovenous malformation was made. During surgery, a peripheral retinal photocoagulation was executed to avoid rebleeding. Postoperatively, fluorescein angiography demonstrated additional macular microangiopathy and diffuse retinal nonperfusion in the periphery. The MRI brain revealed neither cerebral nor orbital vascular anomaly, confirming a group 2 retinal arteriovenous malformation.

Conclusion: Retinal arteriovenous malformations are generally considered stable over time. However, complications due to retinal ischemia can occur. Hence, regular observation is warranted. In so doing, timely treatment can be offered to avoid complications.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. No specific funding was received.

Figures

Figure 1
Figure 1
(a) Fundus of the affected right eye of patient postsurgery, showing enlarged and tortuous vessels extending from the optic disc. A fibrous tuft is visible at the optic disc. (b) Normal fundus of the left eye.
Figure 2
Figure 2
Silver wiring of the retinal veins in the superior (a), inferior (b), and temporal quadrant of the retina (c).
Figure 3
Figure 3
Fluorescein angiography of the affected right eye of the patient. (a) Abnormal arteriovenous communications with microangiopathy in the macula and an enlarged foveal avascular zone. (b, c) Diffuse capillary drop out in retinal periphery. No peripheral neovascularization is observed; however, pictures were taken 2 weeks after peroperative intravitreal anti-VEGF injection.
See this image and copyright information in PMC

References

    1. Dayani P. N., Sadun A. A. A case report of Wyburn-Mason syndrome and review of the literature. Neuroradiology. 2007;49(5):445–456. doi: 10.1007/s00234-006-0205-x. - DOI - PubMed
    1. Wyburn-Mason R. Arteriovenous aneurysm of mid-brain and retina, facial naevi and mental changes. Brain. 1943;66(3):163–203. doi: 10.1093/brain/66.3.163. - DOI
    1. Archer D. B., Deutman A., Ernest J. T., Krill A. E. Arteriovenous communications of the retina. American Journal of Ophthalmology. 1973;75(2):224–241. doi: 10.1016/0002-9394(73)91018-0. - DOI - PubMed
    1. Karagiannis D., Panagiotidis D., Tsoubris I., Theodossiadis P. Spontaneous development of macular ischemia in a case of racemose hemangioma. Clinical Ophthalmology. 2011;5:931–932. doi: 10.2147/opth.s21925. - DOI - PMC - PubMed
    1. Rao P., Thomas B. J., Yonekawa Y., Robinson J., Capone A., Jr. Peripheral retinal ischemia, neovascularization, and choroidal infarction in Wyburn-Mason syndrome. JAMA Ophthalmology. 2015;133(7):852–854. doi: 10.1001/jamaophthalmol.2015.0716. - DOI - PubMed

Publication types

LinkOut - more resources