Severe Polypoidal Choroidal Vasculopathy as a Harbinger of Spontaneous Suprachoroidal Hemorrhage.

Purpose: To report a rare case of spontaneous suprachoroidal hemorrhage in polypoidal choroidal vasculopathy (PCV) and propose a possible pathophysiologic cascade with associated clinical warning signs.

Methods

A single observational case was reviewed.

Results

A 66-year-old man with PCV developed sequential massive submacular hemorrhage, breakthrough vitreous hemorrhage, non-appositional choroidal elevation, and ultimately appositional suprachoroidal hemorrhage with angle closure and ocular hypertension. Despite treatment with posterior sub-Tenon triamcinolone and conservative management, the final visual outcome was no light perception.

Conclusions

Spontaneous suprachoroidal hemorrhage in PCV is an extremely rare but devastating event. Based on the patient's stepwise clinical progression over several follow-up visits, we propose a sentinel cascade involving severe choroidal and vortex vein congestion culminating in blowout hemorrhage into the suprachoroidal space. Recognition of red-flag features may aid in early identification and closer surveillance of high-risk cases.