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   Table of Contents      
BRIEF REPORT
Year : 1999  |  Volume : 47  |  Issue : 3  |  Page : 197-198

Congenital retinal arterial loops and spontaneous vitreous haemorrhage: A case report


Aravind Eye Hospital, Madurai, India

Correspondence Address:
S Satish
Aravind Eye Hospital, Madurai
India
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Source of Support: None, Conflict of Interest: None


PMID: 10858780

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How to cite this article:
Satish S, Mridula A P, Kim R, Chakrabarthi M, Namperumalsamy P. Congenital retinal arterial loops and spontaneous vitreous haemorrhage: A case report. Indian J Ophthalmol 1999;47:197-8

How to cite this URL:
Satish S, Mridula A P, Kim R, Chakrabarthi M, Namperumalsamy P. Congenital retinal arterial loops and spontaneous vitreous haemorrhage: A case report. Indian J Ophthalmol [serial online] 1999 [cited 2019 Sep 20];47:197-8. Available from: http://www.ijo.in/text.asp?1999/47/3/197/14913

This report describes a case of unilateral spontaneous vitreous haemorrhage associated with congenital retinal arterial loops.

Congenital retinal vascular anomalies are an unusual cause of vitreous haemorrhage. These vascular anomalies include retinal telangiectasia, angiomatosis retinae, cavernous hemangioma of the retina, arteriovenous malformations, and abnormal dilation and tortuosity of the large retinal vessles without arteriovenous communications or capillary abnormalities. The last group includes congenital arterial loops on or near the disc, rarely associated with secondary complications. We herein present a case of unilateral spontaneous vitreous haemorrhage in a patient with bilateral retinal arterial loops.


  Case Report Top


A 30-year-old male first came to us on 13 January 1995 for a routine ophthalmic examination. He had a corrected visual acuity of 6/6 in both eyes. The intraocular pressure (IOP) was within the normal range. Anterior segment biomicroscopy of both eyes was unremarkable. Fundus indirect ophthalmoscopy revealed tortuous retinal vessles near the superior portion of the disc in both eyes. Elsewhere the retinal vessels appeared normal and no arteriovenous communications were seen. Slitlamp biomicroscopy with +90D lens showed retinal vascular loops in the superior peripapillary region with kinking of the superonasal vessels in both eyes. Vitreous gel and macula were normal in both eyes.

Fundus fluorescein angiography of the right eye demonstrated normal choroidal filling. Arteriovenous phase showed prominent arterial loops, superior to the disc in the peripapillary area. There was no abnormal blood flow in the arterial loop. The transit phase of the angiogram showed no dye leakage from the arterioles or from adjacent capillary bed (Figure). The patient was asymptomatic and was advised periodic examination.

One year later he presented to us with sudden onset of floaters and mild blurring of vision in his right eye following physical straining during defecation. Visual acuity was 6/12 and 6/6 in the right and left eye respectively. Slitlamp biomicroscopy of the right eye showed few cells in the anterior vitreous face.

Fundus indirect ophthalmoscopy revealed scattered vitreous haemorrhage in the inferior portion. The patient was advised strict bedrest and avoidance of physical exertion. Follow-up examination one month later showed complete resolution of the vitreous haemorrhage and the visual acuity had improved to 6/6.


  Discussion Top


The pre-retinal arterial loops were first described by Liebriech[1] in 1871. Goldstein and Wexler[2] showed that retinal arterial loops are not residual portions of the embryonic hyaloid vasculature but are segmental anomalies involving an otherwise normal branch of the central retinal artery. Bisland[3] reviewed the 52 previously reported eyes with retinal arterial loops and added 7 more cases. In 7 patients the arterial loops occurred bilaterally, and most arterial loops projected into the vitreous although the loops remained in the plane of the optic nerve and peripapillary retina. Limaye, Tang and Pilkerton[4] reported 3 cases of preretinal arterial loops associated with branch arteriole occlusion and extensive cilioretinal circulation. They hypothesized that one form of preretinal arterial loop is associated with complications. Brucker[5] and coworkers reported the first 2 cases of vitreous haemorrhage from congenital arterial loops. In both their cases vitreous haemorrhage occurred after strenuous physical activity.

Similar to cases reported by Brucker[5] and coworkers, our patient also developed vitreous haemorrhage following physical straining, being asymptomatic till then. It is not known whether the haemorrhage occurred from the arterial loop or from the adjacent capillary bed. Vitreous haemorrhage may also occur following an acute posterior vitreous detachment (PVD). This is commonly seen in older patients, and spontaneous vitreous haemorrhage is uncommon in young nonmyopic patients. Definitive posterior vitreous detachment was not identified in our patient. Vitreous haemorrhage due to preretinal or prepapillary vascular loops are usually mild and undergo spontaneous resolution; rarely thay may be recurrent and may require pars plana vitrectomy.[6] Retinal arterial loops are rare causes of spontaneous vitreous haemorrhage and should be considered in the differential diagnosis of spontaenous vitreous haemorrhage in young patients with no systemic illness.

 
  References Top

1.
Liebriech R. Demonstration of diseases of the eye. Persistent hyaloid artery and vein. Trans Pathol Soc London 1871;22:222.  Back to cited text no. 1
    
2.
Goldstin I, Wexler D. The preretinal artery. An anatomic study. Arch Ophthalmol 1929;1:324.  Back to cited text no. 2
    
3.
Bisland T. Vascular loops in the vitreous. Arch Ophthalmol 1953;49:514.  Back to cited text no. 3
[PUBMED]    
4.
Limaye S.R., Tang RA, Pilkerton AR. Cillioretinal circulation and branch arterial occlusion associated with preretinal arterial loops. Am J Ophthalmol 1980;89:834-39.  Back to cited text no. 4
    
5.
Brucker AJ, Michels RG, Fine SL. Congenital retinal arterial loops and vitreous haemorrhage. Am J Ophthalmol 1977;84:220-23.  Back to cited text no. 5
[PUBMED]    
6.
Straasman IB, Desai U. Prepapillary vascular loop and a recurrent vitreous haemorrhage. Retina 1997;17:166-67.  Back to cited text no. 6
    


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