Petalloid Foveal Hemorrhage in a Patient With High Myopia

A21-YEAR-OLD MAN with myopic degeneration was examined because of a sudden onset of decreased vision in his right eye. He denied recent trauma or Valsalva maneuver. His ocular history was significant for high myopia (OD, �14.00 diopters [D]; OS, �16.00 D) and cryotherapy in both eyes for peripheral tears associated with lattice degeneration. On examination, visual acuity was 20/400 OD and 20/30 OS. Fundus examination showed tilted myopic discs with multiple lacquer cracks and irregular changes in the retinal pigment epithelium. A stellate intraretinal hemorrhage was present in the fovea of his right eye (Figure 1). The hemorrhage was organized in a peculiar petalloid pattern with feathery distal edges, suggesting localization within the radially oriented Henle fiber layer. An optical c oherence t omograph (Figure 2) showed areas of high backscattering and shadowing of the underlying retinal pigment epithelium, consistent with hemorrhage in the intraretinal space. Fluorescein a ngiography showed a blocking defect corresponding to the hemorrhage. No late leakage was noted (Figure 3). A late-phase indocyanine green angiogram also showed no choroidal leakage or neovascularization (Figure 4). At 12 months’ followup, the foveal hemorrhage had resolved, leaving 20/50 vision. A new lacquer crack was noted near the fovea, which may account for the patient’s decreased vision. COMMENT