Fundus autofluorescence imaging of subinternal limiting membrane hemorrhage in anemic retinopathy

Manuscript received: 03.05.17; Revision accepted: 08.08.17 We describe the evolution of subinternal limiting membrane (ILM) hemorrhage associated with anemic retinopathy on fundus autofluorescence (FAF) and spectral domain optical coherence tomography (OCT). A 27-year-old male with megaloblastic anemia complained of defective vision in the right eye (RE). Fundus examination revealed multiple Roth spots bilaterally suggestive of anemic retinopathy. Preretinal hemorrhage was seen over the fovea and temporally in the RE which appeared hypoautofluorescent on FAF and as hyperreflective echoes beneath an elevated ILM on OCT. Hemorrhages resolved following treatment with blood transfusion, folate, and Vitamin B12 supplements. Sub-ILM hemorrhage transformed into a yellow spot at macula which was hyperautofluorescent on FAF and hyperreflective on OCT and then resolved leaving a small sub-ILM hyporeflective cavity. Recent sub-ILM hemorrhage is hypoautofluorescent as fresh blood has no autofluorescence while altered blood is hyperautofluorescent due to bilirubin in the degraded heme which is an endogenous fluorophore.