Recurrent Retinal Hemorrhage in High Myopia - Ophthalmology

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Recurrent retinal hemorrhage in individuals with high myopia is indeed a concerning issue and can arise from several underlying mechanisms. High myopia, defined as a refractive error greater than -6.00 diopters, is associated with various structural changes in the eye, particularly in the retina and the vitreous body. These changes can predispose individuals to retinal complications, including hemorrhage.

One of the primary reasons for recurrent retinal hemorrhage in high myopia is the presence of degenerative changes in the retina. In highly myopic eyes, the retina is often thinner and more susceptible to tears and breaks. These structural weaknesses can lead to the formation of retinal tears, which may allow blood vessels to bleed into the retinal layers, resulting in hemorrhage. Additionally, the elongation of the eyeball in high myopia can cause traction on the retina, further increasing the risk of bleeding.

Another potential cause of recurrent hemorrhage is the presence of posterior vitreous detachment (PVD). In high myopia, the vitreous gel can become liquefied and detach from the retina more frequently. When the vitreous detaches, it can pull on the retina, leading to tears and subsequent bleeding. Even in cases where new blood vessel growth (neovascularization) has been ruled out, the mechanical effects of PVD can still result in recurrent bleeding episodes.

Furthermore, the presence of lattice degeneration, a common condition in high myopia, can also contribute to retinal hemorrhage. Lattice degeneration is characterized by thinning and atrophy of the peripheral retina, which can lead to retinal tears and hemorrhage. Regular monitoring and examination by an ophthalmologist are crucial for individuals with high myopia to detect these changes early.

In your case, since you have already undergone examinations that ruled out neovascularization, it would be prudent to consider these other factors. A comprehensive evaluation, including optical coherence tomography (OCT) and possibly a fluorescein angiography, may help identify any structural changes or tears in the retina that could be contributing to the recurrent bleeding.

Management of recurrent retinal hemorrhage in high myopia often involves a combination of monitoring and, in some cases, surgical intervention. If a retinal tear is identified, procedures such as laser photocoagulation or cryotherapy may be necessary to seal the tear and prevent further bleeding. Additionally, addressing any underlying vitreous issues may also be beneficial.

In conclusion, recurrent retinal hemorrhage in high myopia can occur due to various factors, including retinal tears, PVD, and lattice degeneration. It is essential to maintain regular follow-ups with your eye care provider to monitor the condition of your retina and to discuss any new symptoms or changes in vision. Early detection and intervention can significantly reduce the risk of vision loss associated with these complications.