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Intrapapillary Hemorrhage with Adjacent Peripapillary Subretinal Hemorrhage in a 9-Year-Old Girl: A Case Report
Chiaki Nakamura1, Tadashi Matsumoto1,2, Norihiro Watanabe1
1Department of Ophthalmology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan.
Insights
Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) is typically seen in myopic women. This report details the youngest patient, a 9-year-old girl, diagnosed with IHAPSH, highlighting myopia
Area of Science:
- Ophthalmology
- Retinal Diseases
Background:
- Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) is a rare condition.
- IHAPSH typically affects myopic women and has not been previously reported in patients under 10 years old.
Observation:
- A 9-year-old girl with advanced myopia presented with decreased visual acuity in her left eye.
- Ophthalmoscopy revealed intrapapillary hemorrhage and peripapillary subretinal hemorrhage, with an elongated ocular axis (24.87 mm).
- Fluorescein angiography showed no optic disc leakage.
Findings:
- The patient was diagnosed with IHAPSH, the youngest reported case to date.
- Hemorrhage absorption was nearly complete within 8 weeks without recurrence.
- Optic disc morphology and progressive myopia are suggested contributing factors.
Implications:
- This case expands the known age range for IHAPSH.
- It emphasizes the role of optic disc characteristics and myopia in IHAPSH.
- Highlights the need to consider IHAPSH in the differential diagnosis of optic disc hemorrhage in children.
Introduction:
Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) is a syndrome associated with intrapapillary hemorrhage and peripapillary subretinal hemorrhage that commonly occurs in myopic women. There have been no reports of patients younger than 10 years. We report a case of typical IHAPSH that occurred in a 9-year-old girl in the advanced stages of myopia.
Case Presentation:
A 9-year-old girl presented with gradually decreasing uncorrected visual acuity in the left eye over the past year, without complaints of floaters or blurred vision. Uncorrected visual acuity was 20/16 in the right eye and approximately 20/285 in the left eye, improving to 20/16 with -4.50 diopters sphere and -0.50 diopters cylinder at 165°. Ophthalmoscopic examination revealed intrapapillary hemorrhage and nasal peripapillary subretinal hemorrhage in her left eye. The left eye had a small, tilted papilla. Fluorescein angiography showed no leakage from the papilla. The length of the ocular axis was elongated to 24.87 mm in the left, compared to 23.15 mm in the right. We diagnosed IHAPSH and decided to follow the patient. After 8 weeks, the hemorrhage was almost completely absorbed. No recurrence has been observed since then.
Conclusion:
To our knowledge, this is the youngest reported case of IHAPSH. This case underscores the potential contribution of optic disc morphology and progressive myopia to IHAPSH pathogenesis and highlights the importance of considering this condition in the differential diagnosis of optic disc hemorrhage in school-aged children.
