Horse-shoe-shaped preretinal hemorrhage in ruptured retinal artery macroaneurysm

A 53-year-old female, known hypertensive, developed sudden unilateral floaters. Fundus showed a ruptured retinal artery macroaneurysm (RAM) causing multilayered hemorrhage superotemporally, with preretinal hemorrhage (PRH) assuming a horse-shoe configuration [Fig. 1a].[1] Optical coherence tomography showed a classic hyperreflective round lesion with dark lumen at the site of RAM and a firmly adherent posterior hyaloid at the fovea which was shielding the center from the PRH [Fig. 1b,c].[2] Her vision was 20/30 bilaterally. Observation was advised, but she was lost to follow-up. This extraordinary pattern of PRH circumventing the fovea might have resulted due to the strong vitreomacular adhesion which also helped preserve the vision.[3]Figure 1: (a) Fundus image showing RAM (yellow star) with multilayered hemorrhage. PRH (blue arrow) and subretinal hemorrhage (yellow arrow). (b) OCT showing RAM with surrounding dense intraretinal hemorrhage causing backshadowing (yellow star) with PRH (blue arrow). There is mild vitreous hemorrhage (green arrow). (c) OCT showing VMA at fovea with adjacent PRH (blue arrow)Authors’ contributions Romana Fazal: Conceptualization, design, manuscript preparation editing and review, literature search. Kousik Sarkar: Data acquisition and analysis. Manuscript editing and review. Avijit Maity: Data acquisition, literature search and reference formatting. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.