Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with only minor platelet deficit in idiopathic thrombocytopenic purpura
A 45-year-old female with underlying ITP and diabetes mellitus presented to the Department of Ophthalmology, Hospital Raja Perempuan Zainab II, complaining of a sudden onset of reduced vision in both eyes, of about 3 weeks in duration. This was associated with floaters in both eyes. There was no history of trauma, intense aerobic exercise, heavy lifting, straining on the toilet, vomiting, coughing, or vigorous sexual activity. She had been diagnosed with ITP several years before, with initial presentation of menorrhagia. Examination revealed visual acuity of 6/36 and 6/60 in the right and left eyes, respectively. Anterior segment findings were unremarkable. Fundus examination showed bilateral peripapillary, subhyaloid and vitreous hemorrhage, which was more pronounced in the left eye (). There were no diabetic retinopathy changes noted. Systemic examination did not reveal any petechiae, bruises, or mucosal bleeding.\nHematological evaluation was carried out. The patient’s platelet count was 120×109/L (normal: 150−450×109/L); her hemoglobin count was 93 g/L (normal: 120–160 g/L). Coagulation profile (prothrombin time and partial thromboplastin time) was normal.\nAfter consultation by a hematologist, she was treated with oral prednisolone, starting dose of 50 mg daily (1 mg/kg/day) for 1 week. Oral prednisolone treatment was then slowly tapered down over the next month. Review at 6 weeks showed spontaneous partial resolving of hemorrhages (), and slight improvement of vision (to 6/24 – both eyes). It was recommended to the patient that she undergo left eye vitrectomy (in view of the fact the subhyaloid hemorrhage was just adjacent to the macula), but the patient has not yet consented to the operation.