Abstract
A patient with hypertension, obstructive sleep apnea, and prior mitral valve repair presented with five days of blurred vision in the right eye. Uncorrected visual acuity was 20/200 OD and 20/20 OS, with normal intraocular pressures and no relative afferent pupillary defect. Anterior segment examination demonstrated 1+ nuclear sclerosis and vitreous syneresis bilaterally. Dilated fundus examination of the right eye demonstrated a massive subretinal hemorrhage involving the temporal macula and extending into the inferior mid-periphery, with mass-like elevation and without foveal involvement. Fluorescein angiography demonstrated intact arteriovenous circulation overlying the lesion with blockage of choroidal fluorescence corresponding to the hemorrhage, and late leakage from a polypoidal peripheral lesion. There was no intrinsic tumor circulation or double circulation pattern to suggest melanoma. The constellation of a temporal peripheral hemorrhagic lesion in an older hypertensive woman, with polypoidal leakage and absent intrinsic vascularity, established the diagnosis of PEHCR. The patient received four monthly intravitreal bevacizumab injections. Widefield imaging at one year demonstrated near-complete hemorrhage resolution with residual pigmentary change, subretinal pigment migration, and temporal macular drusen. At twenty years, the macula remained flat with preserved foveal architecture and no recurrent hemorrhage or exudation. Best-corrected visual acuity was 20/25. PEHCR is an underrecognized peripheral degeneration that most commonly regresses spontaneously but may warrant anti-VEGF therapy when the macula is threatened. Recognition avoids misdiagnosis, and this case demonstrates durable anatomic and functional stability across two decades.
Presentation Date: 08/06/2026
Issue Date: 09/25/2026
