Herzig Eye Institute

BackgroundTo describe the clinical presentation and characteristic imaging features of deep retinal haemorrhages primarily located in the Henle fibre layer (HFL) of the macula. The spectrum of aetiologies and a comprehensive theory of pathogenesis are presented.MethodsThis is a retrospective, multicentre case series evaluating eyes with retinal haemorrhage in HFL. Clinical features, underlying aetiology, systemic and ocular risk factors, visual acuity, and multimodal imaging including fundus photography and cross-sectional and en face optical coherence tomography (OCT) are presented.ResultsRetinal haemorrhages localised to HFL in 33 eyes from 23 patients were secondary to acute blunt trauma to the head (n=2), eye (n=1) and trunk (n=1), ruptured intracranial aneurysm (Terson’s syndrome, n=3), general anaesthesia (n=1), epidural anaesthesia (n=1), hypertension with anaemia (n=1), decompression retinopathy (n=1), postvitrectomy with intraocular gas (n=1), retinal vein occlusion (n=7), myopic degeneration (n=2), macular telangiectasia type 2 (n=1), and polypoidal choroidal vasculopathy (n=1). Defining clinical features included deep retinal haemorrhage with feathery margin and petaloid pattern radiating from the fovea. OCT demonstrated characteristic hyper-reflectivity from the haemorrhage delineated by obliquely oriented fibres in the Henle layer. Spontaneous resolution of HFL haemorrhage occurred after 3 months in 15 patients with follow-up.ConclusionThe characteristic petaloid-shaped, deep intraretinal haemorrhage with a feathery margin localised to HFL is associated with various disorders. The terminology ‘Henle fiber layer hemorrhage (HH)’ is proposed to describe the clinical and OCT findings, which may result from abnormal retinal venous pressure from systemic or local retinovascular disorders affecting the deep capillary plexus or from choroidal vascular abnormalities.

To report a case of a choroidal macrovessel imaged using enhanced depth imaging spectral domain optical coherence tomography (EDI-OCT) and describe the choroidal features. a 42-year-old man presented with metamorphopsia. Multimodal imaging, including color fundus photography, near-infrared reflectance, and EDI-OCT was used to describe a choroidal macrovessel. Initial ophthalmic examination revealed a serpentine-shaped subretinal pattern deep to the retina near the fovea. When the color image was subjected to a red filter, a large diameter vessel could be seen coursing from the fovea to the temporal macula. EDI-OCT of the choroidal macrovessel revealed a thickened choroid and mild deformation of both the ellipsoid zone and the choroidal-scleral junction. En face spectral domain optical coherence tomography at the level of the choroid demonstrated the anomalous vessel. EDI-OCT and en face optical coherence tomography, used in conjunction with other imaging modalities, can be used to demonstrate the presence and pattern of a choroidal macrovessel. A thickened choroid and overlying outer retinal indentation was observed in association of the choroidal macrovessel. These imaging tools can help distinguish this condition from other diagnoses with a similar appearance, such as ophthalmomyiasis.