PERIPHERAL EXUDATIVE HEMORRHAGIC CHORIORETINOPATHY - PEHCR

Abstract

Introduction. Peripheral exudative hemorrhagic chorioretinopathy is a serious disease characterized by subretinal hemorrhage and exudates. Although the disease may be asymptomatic, the classical clinical signs and symptoms are subjective difficulties due to visual decrease, onset of floaters, phenomenon of photopsia or metamorphosia. The aim of this study was to present an explicit case of this disease, to stress its importance and to raise awareness concerning this disease, which would be important in the education of doctors involved in the pathology of the posterior eye segment. Case report. A 56-year-old female was presented with decreased visual acuity involving both eyes, more prominent in the right eye. Medical history revealed that her first symptoms appeared 10 years ago, with difficulty focusing on objects that are up close. On examination the visual acuity in the right eye was BCVA 0.02 cc, and in the left eye BCVA 0.5 cc. Bilateral intraocular pressure was 14.6 mmHg, and biomicroscopy of the anterior segment showed a normal finding. Macula lutea in the fundus was with prominent atrophic changes of pigment epithelium and tiny hyperpigmentations, with few drusen, atrophic changes of choriocapillaris with exposition of the large choroidal blood vessels. Atrophic choroidal lesions with whitish drusen-like changes were observed in pre-equatorial segment periphery and in the equator circumferentially, especially visible temporally. In the peripheral fundus, near the equator as well as anteriorly, large hemorrhagic zones were seen located subretinally with zones of subretinal fibrosis shaped as grey-whitish plaques or strip-shaped that easily elevated the retina, but zones of serious retinal detachment were also present. Optical coherence tomography (OCT) showed distinct atrophy of pigment epithelium and choriocapillaris with choroidal hyperreflexia and visible lacunar spaces in the large blood vessels. No vascular changes in the retina and choroid or newly formed blood/vascular network were observed on OCT angiography. It is important to point out that the patient has got hypertension ang has been undergoing dialysis for 8 years. Conclusion. A case with a rare, unusual disease that can pose a significant diagnostic problem has been presented. This disease is also a common cause for visual acuity impairment and there is still no standard approach to its treatment. Therefore, having in mind the presented dilemmas, awareness of this entity is of substantial importance in clinical ophthalmology practice. This paper, by presenting this case report is beneficial for the doctors dealing with this pathology.