Subretinal hemorrhages associated with angioid streaks following a mild ocular trauma
A young male patient aged of 30 year old presented in the out-patients department with a sudden severe decreasing of visual acuity following a mild ocular trauma in the left eye which occurred one month prior.\nVisual acuities at presentation were 20/20 in the right eye (RE) and 20/200 in the left eye (LE). Slit lamp examination found in both eyes clear cornea, anterior chamber normally deep and quiet, clear lens, and a normal intraocular pressure. Fundus examination found angioid streaks (AS) emanating from the optic disc in both eyes with “peau d’orange” aspect [Figures and ]. Furthermore, we noted submacular hematoma with disciform scaring of the macula and two other subretinal hemorrhages laying nasal and inferior to the optic disc in the left eye []. To this was associated a linear rupture of Bruch's membrane located inside the main submacular hemorrhage. Systemic examination found skin changes in the neck and the axillary space compatible with PXE. This was confirmed later by a skin biopsy. Fluorescein angiography [] showed staining along with Bruch's membrane rupture and angioid streaks. No neovascularization was noted in both eyes. The ocular coherence tomography (OCT) of the left eye showed macular detachment by effusion of submacular hemorrhage []. The splitting is located in the space between the neuroepithelium (NE) and the retinal pigment epithelium. Also is noted, hypereflectivity and thickening of the photoreceptors’ layer, compatible with the disciform macular scar aspect. At the level of the Bruch's membrane rupture, the macular OCT showed fusion of the RPE, choroid, and NE [].\nThe course was characterized by resolution of hemorrhage and occurrence of a fibrosis scaring of the macula after 4 months with no improvement of visual acuity []. At this stage, macular OCT showed reabsorption of hemorrhages, diffuse hypereflectivity, and thickening of the photoreceptors’ layer [].