Vitreous hemorrhage from a persistent hyaloid artery

Area of Science:

• Ophthalmology
• Vascular Biology
• Retinal Circulation

Background:

• The hyaloid artery is a transient embryonic vessel crucial for fetal eye development.
• Persistence of the hyaloid artery is a rare congenital anomaly.
• Vitreous hemorrhage is bleeding into the vitreous humor, often associated with various ocular pathologies.

Observation:

• A 14-year-old female presented with spontaneous vitreous hemorrhage.
• The hemorrhage originated from the free end of a partially regressed hyaloid artery.
• Fluorescein angiography indicated the bleeding stemmed from the retinal arterial system.

Findings:

• The affected hyaloid artery transformed into a fibrosed, occluded, and semitransparent thread over 20 months.
• Rapid eye movement (REM) sleep was hypothesized to induce tractional forces leading to arterial rupture.
• Patent persistent hyaloid artery is identified as a potential cause of vitreous hemorrhage.

Implications:

• This case highlights a rare but significant cause of vitreous hemorrhage in young, otherwise healthy patients.
• Ophthalmologists should consider patent persistent hyaloid artery in the differential diagnosis of unexplained vitreous hemorrhage.
• Understanding the biomechanics of REM sleep may offer insights into the rupture mechanism of such anomalies.