Vitreous Hemorrhage Induced by a Persistent Hyaloid Artery

The hyaloid artery is a branch of the ophthalmic artery and part of the fetal hyaloid vascular system; failure of these fetal vessels to regress can lead to a persistent hyaloid artery (PHA). PHA can induce complications, including amblyopia, cataracts, glaucoma, vitreous hemorrhage, and retinal detachment. We present a case of vitreous hemorrhage secondary to traction of the PHA in an infant treated for threshold retinopathy of prematurity (ROP).

A 660-g female infant was born at 23 weeks of gestation and was found to have bilateral Stage 3 Zone 2 ROP with plus disease, prompting laser photocoagulation to the avascular retina. Six weeks after this treatment, the patient was found to have a vitreous hemorrhage requiring vitrectomy. The etiology of the hemorrhage was thought to be secondary to traction on the PHA after laser photocoagulation treatment. She developed subsequent anisometropic myopia and amblyopia, for which she continues care.

Vitreous hemorrhage is a rare but severe complication of PHA. This unique case of traction on the PHA with subsequent vitreous hemorrhage after routine treatment of ROP highlights the importance of considering PHA in the management of ROP.