# Vitreous hemorrhage in retinal vein occlusion without visible traction from the posterior vitreous membrane: An optical coherence tomography angiography case report study

## TL;DR

This case report describes a retinal vein occlusion with vitreous hemorrhage that occurred without visible vitreous traction, highlighting a new understanding of the condition.

## Contribution

The study presents a rare case of vitreous hemorrhage in retinal vein occlusion without posterior vitreous membrane traction, challenging existing pathophysiological assumptions.

## Key findings

- Vitreous hemorrhage occurred without visible traction from the posterior vitreous membrane at the bleeding point.
- Neovascularization infiltrated the vitreous cavity, leading to substantial bleeding.
- Vitrectomy successfully removed neovascularization and improved visual acuity.

## Abstract

We report an unusual case of retinal vein occlusion (RVO) associated with vitreous hemorrhage (VH) without visible traction from the posterior vitreous membrane (PVM) at the bleeding point, challenging our current understanding of VH pathophysiology.

A 52-year-old man presented with VH in the right eye. A detailed examination using optical coherence tomography angiography (OCTA) and ultra-widefield fluorescein angiography revealed branch RVO with non-perfused areas (NPAs) extending peripherally and neovascularization elsewhere (NVE). OCTA showed NVE infiltrating the vitreous cavity, leading to substantial bleeding without visible PVM traction at the bleeding point. The NVE was successfully removed following vitrectomy, and visual acuity improved from 20/20 to 20/13 preoperatively, along with a postoperative improvement in floaters.

This unique case of RVO suggests the possibility of VH occurring independent of PVM contractions at the bleeding point, challenging the traditional understanding of VH. This finding underscores the potential role of OCTA in diagnosing and managing retinal vascular diseases, underscoring the need for further investigations into the underlying mechanisms, with potential implications for personalized therapeutic strategies.

•Retinal vein occlusion often results in retinal non-perfused areas.•Ultra-widefield fluorescein angiography could detect retinal non-perfused areas.•The bleeding point lacked visible posterior vitreous membrane traction.•Vitrectomy removed the neovascularization and improved visual acuity.

Retinal vein occlusion often results in retinal non-perfused areas.

Ultra-widefield fluorescein angiography could detect retinal non-perfused areas.

The bleeding point lacked visible posterior vitreous membrane traction.

Vitrectomy removed the neovascularization and improved visual acuity.