# Unmasking a Silent Persistent Hyaloid Artery: A Rare Cause of Vitreous Hemorrhage in an Elderly Patient

## TL;DR

An elderly man experienced sudden vision loss due to a rare ruptured hyaloid artery, successfully treated with surgery.

## Contribution

This case expands the known age range for symptomatic persistent hyaloid artery and highlights early vitrectomy as a treatment.

## Key findings

- A 70-year-old patient had a ruptured persistent hyaloid artery causing vitreous hemorrhage.
- Early vitrectomy successfully cauterized the bleeding vessel and restored vision.
- No retinal tears or detachment were found, confirming the rare cause of the hemorrhage.

## Abstract

Persistent hyaloid artery (PHA) rupture is a rare cause of vitreous hemorrhage, particularly in older adults, as hyaloid remnants typically regress during early life. We report the case of a 70-year-old man who presented with sudden, painless vision loss in the left eye due to dense vitreous hemorrhage. Immediate pars plana vitrectomy was performed, during which an actively bleeding PHA was identified and successfully cauterized. Intraoperative video documentation provided direct visualization of the ruptured embryonic vessel, confirming the diagnosis. No retinal tears, retinal detachment, or neovascularization were noted. Postoperatively, the patient experienced progressive visual recovery, ultimately returning to his baseline visual acuity. This case expands the known age spectrum of symptomatic PHA, demonstrates the diagnostic and therapeutic value of early vitrectomy in non-clearing hemorrhage, and underscores the importance of considering congenital vascular remnants in the differential diagnosis of spontaneous vitreous hemorrhage in elderly patients.