Henle Fibre Layer Haemorrhage after a Valsalva Manoeuvre

Abstract

A male patient, 59 years of age, presented with sudden deterioration of visual acuity (VA) caused by a Henle fibre layer haemorrhage (HFLH) in our outpatient department. He reported being under treatment with acetylsalicylic acid and experienced a Valsalva manoeuvre before he observed reduced vision. Due to the impairment caused by the haemorrhage, disturbing the patient’s daily activities, intravitreal injection of recombinant tissue plasminogen activator combined with SF6 and bevacizumab was offered. After this procedure, the HFLH disappeared, VA improved from 20/40 to 20/20 (Snellen) 3 months after treatment and a typical hyperreflective vertical line was seen in optical coherence tomography.

Henle fiber layer hemorrhage as the first manifestation of factor V Leiden homozygous mutation

“…2 However, patients with decreased visual acuity affecting daily life activities or those with ellipsoid zone involvement may benefit from recombinant tissue plasminogen activator (r-TPA), sulfur hexafluoride (SF6) and anti-vascular endothelial growth factor (anti-VEGF), with or without vitrectomy, to displace the hemorrhages from the fovea. 10 The remaining patients, presenting with underlying eye disorders, such as aged-related macular degeneration, retinal vein occlusions or macular telangiectasia (Mac Tel), require specific treatment. 2 In our case, the improvement was fast and the ellipsoid band was not involved, hence no therapy was initiated.…”