PMC8077655_01
PMC8077655_02
Montage of multimodal imaging at first visit - near infrared reflectance (a) shows a hyporeflectant oval lesion, corresponding to a HFLH (appearing as hyperreflective lesion in the OCT) in the enhanced depth image OCT (b). Fundus autofluorescence (c), fluorescein angiography (d), early and late indocyanine angiography (e, f) show no signs of vascular pathology or macular neovascularization. HFLH, Henle fibre layer haemorrhage; OCT, optical coherence tomography; MNV, macular neovascularization.
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F1
To investigate the origin of the haemorrhage, we conducted multimodal imaging including an OCT with enhanced depth imaging, OCT angiography (OCTA), fluorescein, and indocyanine green angiography (Fig. 1, 2).
OCTA at first visit - enface optical coherence angiography (a) and OCTA slab of deep capillary plexus (b) with according OCTA b-scans (c, d) displaying the HFLH with underlying shadowing artefact. HFLH, Henle fibre layer haemorrhage; OCTA, optical coherence tomography angiography; OCT, optical coherence tomography.
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F2
To investigate the origin of the haemorrhage, we conducted multimodal imaging including an OCT with enhanced depth imaging, OCT angiography (OCTA), fluorescein, and indocyanine green angiography (Fig. 1, 2).
OCT at first presentation - HFLH shows a discrete involvement of the ellipsoid zone. HFLH, Henle fibre layer haemorrhage; OCT, optical coherence tomography.
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F3
Since the decreased VA severely affected the patient's daily activities and the discrete involvement of the ellipsoid zone in the haemorrhage (Fig. 3), intravitreal injection of 0.1 mL rTPA (50 microg) combined with 0.2 mL of 100% SF6 and 0.05 mL bevacizumab was offered to the patient 1 day after occurrence of the HFLH.
OCT follow-up - OCT scans 1 day after surgery (a) with already diminished HFLH, absorption at month one (b) and restoration of the ellipsoid zone 8 weeks after surgery (c). HFLH, Henle fibre layer haemorrhage; OCT, optical coherence tomography.
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F4
At the follow-up examination 1 month after surgery, the HFLH was no longer present, leaving a typical hyperreflective vertical line in OCT (Fig. 4), and VA was improved from 20/40 to 20/25 Snellen 2 months and 20/20 Snellen 3 months after surgery.