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Henle fibre layer haemorrhage: clinical features and pathogenesis.
Br J Ophthalmol. 2021 03; 105(3):374-380.BJ

Abstract

BACKGROUND

To describe the clinical presentation and characteristic imaging features of deep retinal haemorrhages primarily located in the Henle fibre layer (HFL) of the macula. The spectrum of aetiologies and a comprehensive theory of pathogenesis are presented.

METHODS

This is a retrospective, multicentre case series evaluating eyes with retinal haemorrhage in HFL. Clinical features, underlying aetiology, systemic and ocular risk factors, visual acuity, and multimodal imaging including fundus photography and cross-sectional and en face optical coherence tomography (OCT) are presented.

RESULTS

Retinal haemorrhages localised to HFL in 33 eyes from 23 patients were secondary to acute blunt trauma to the head (n=2), eye (n=1) and trunk (n=1), ruptured intracranial aneurysm (Terson's syndrome, n=3), general anaesthesia (n=1), epidural anaesthesia (n=1), hypertension with anaemia (n=1), decompression retinopathy (n=1), postvitrectomy with intraocular gas (n=1), retinal vein occlusion (n=7), myopic degeneration (n=2), macular telangiectasia type 2 (n=1), and polypoidal choroidal vasculopathy (n=1). Defining clinical features included deep retinal haemorrhage with feathery margin and petaloid pattern radiating from the fovea. OCT demonstrated characteristic hyper-reflectivity from the haemorrhage delineated by obliquely oriented fibres in the Henle layer. Spontaneous resolution of HFL haemorrhage occurred after 3 months in 15 patients with follow-up.

CONCLUSION

The characteristic petaloid-shaped, deep intraretinal haemorrhage with a feathery margin localised to HFL is associated with various disorders. The terminology 'Henle fiber layer hemorrhage (HH)' is proposed to describe the clinical and OCT findings, which may result from abnormal retinal venous pressure from systemic or local retinovascular disorders affecting the deep capillary plexus or from choroidal vascular abnormalities.

Authors+Show Affiliations

Ophthalmology, New England Eye Center, Boston, Massachusetts, USA cbaumal@gmail.com.Retina Department, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA.Ophthalmology, New England Eye Center, Boston, Massachusetts, USA.Retina Department, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA.Ophthalmology, New England Eye Center, Boston, Massachusetts, USA.University Eye Clinic, San Giuseppe Hospital, Milan, Italy.Ophthalmology, Ospedale San Raffaele, Milano, Italy.Vitreoretinal Surgery, Herzig Eye Institute, Toronto, Ontario, Canada.Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.Retina Department, Jules Stein Eye Institute, Los Angeles, California, USA.Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Milan, Italy.Retina Department, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.Department of Ophthalmology, Lariboisière Hospital, University of Paris 7 Denis Diderot, Paris, France.Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil.Ophthalmology, North Shore-Long Island Jewish, Great Neck, New York, USA.University Eye Clinic, San Giuseppe Hospital, Milan, Italy.Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California, USA.Retina Department, Vitreous Retina Macula Consultants of New York, New York, New York, USA.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32376610

Citation

Baumal, Caroline R., et al. "Henle Fibre Layer Haemorrhage: Clinical Features and Pathogenesis." The British Journal of Ophthalmology, vol. 105, no. 3, 2021, pp. 374-380.
Baumal CR, Sarraf D, Bryant T, et al. Henle fibre layer haemorrhage: clinical features and pathogenesis. Br J Ophthalmol. 2021;105(3):374-380.
Baumal, C. R., Sarraf, D., Bryant, T., Gui, W., Muakkassa, N., Pichi, F., Querques, G., Choudhry, N., Teke, M. Y., Govetto, A., Invernizzi, A., Eliott, D., Gaudric, A., Cunha de Souza, E., Naysan, J., Lembo, A., Lee, G. C., & Freund, K. B. (2021). Henle fibre layer haemorrhage: clinical features and pathogenesis. The British Journal of Ophthalmology, 105(3), 374-380. https://doi.org/10.1136/bjophthalmol-2019-315443
Baumal CR, et al. Henle Fibre Layer Haemorrhage: Clinical Features and Pathogenesis. Br J Ophthalmol. 2021;105(3):374-380. PubMed PMID: 32376610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Henle fibre layer haemorrhage: clinical features and pathogenesis. AU - Baumal,Caroline R, AU - Sarraf,David, AU - Bryant,Tara, AU - Gui,Wei, AU - Muakkassa,Nora, AU - Pichi,Francesco, AU - Querques,Giuseppe, AU - Choudhry,Netan, AU - Teke,Mehmet Yasin, AU - Govetto,Andrea, AU - Invernizzi,Alessandro, AU - Eliott,Dean, AU - Gaudric,Alain, AU - Cunha de Souza,Eduardo, AU - Naysan,Jonathan, AU - Lembo,Andrea, AU - Lee,Grace C, AU - Freund,K Bailey, Y1 - 2020/05/06/ PY - 2019/12/23/received PY - 2020/04/06/revised PY - 2020/04/08/accepted PY - 2020/5/8/pubmed PY - 2020/5/8/medline PY - 2020/5/8/entrez KW - anatomy KW - imaging KW - macula KW - retina SP - 374 EP - 380 JF - The British journal of ophthalmology JO - Br J Ophthalmol VL - 105 IS - 3 N2 - BACKGROUND: To describe the clinical presentation and characteristic imaging features of deep retinal haemorrhages primarily located in the Henle fibre layer (HFL) of the macula. The spectrum of aetiologies and a comprehensive theory of pathogenesis are presented. METHODS: This is a retrospective, multicentre case series evaluating eyes with retinal haemorrhage in HFL. Clinical features, underlying aetiology, systemic and ocular risk factors, visual acuity, and multimodal imaging including fundus photography and cross-sectional and en face optical coherence tomography (OCT) are presented. RESULTS: Retinal haemorrhages localised to HFL in 33 eyes from 23 patients were secondary to acute blunt trauma to the head (n=2), eye (n=1) and trunk (n=1), ruptured intracranial aneurysm (Terson's syndrome, n=3), general anaesthesia (n=1), epidural anaesthesia (n=1), hypertension with anaemia (n=1), decompression retinopathy (n=1), postvitrectomy with intraocular gas (n=1), retinal vein occlusion (n=7), myopic degeneration (n=2), macular telangiectasia type 2 (n=1), and polypoidal choroidal vasculopathy (n=1). Defining clinical features included deep retinal haemorrhage with feathery margin and petaloid pattern radiating from the fovea. OCT demonstrated characteristic hyper-reflectivity from the haemorrhage delineated by obliquely oriented fibres in the Henle layer. Spontaneous resolution of HFL haemorrhage occurred after 3 months in 15 patients with follow-up. CONCLUSION: The characteristic petaloid-shaped, deep intraretinal haemorrhage with a feathery margin localised to HFL is associated with various disorders. The terminology 'Henle fiber layer hemorrhage (HH)' is proposed to describe the clinical and OCT findings, which may result from abnormal retinal venous pressure from systemic or local retinovascular disorders affecting the deep capillary plexus or from choroidal vascular abnormalities. SN - 1468-2079 UR - https://www.unboundmedicine.com/medline/citation/32376610/Henle_fibre_layer_haemorrhage:_clinical_features_and_pathogenesis_ L2 - https://bjo.bmj.com/lookup/pmidlookup?view=long&pmid=32376610 DB - PRIME DP - Unbound Medicine ER -