Photodiagnosis and photodynamic therapy · 2026
Clinical Characteristics, Risk Factors, and Prognosis of Intrapapillary Hemorrhage and Peripapillary Subretinal Hemorrhage: A Systematic Review.
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Jia Yiran, Zhou Haiying, Jiang Libin, He Hai-Long
Аннотация
PURPOSE: To systematically summarize the clinical characteristics, anatomical risk factors, imaging findings, pathophysiological mechanisms, and prognosis of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) and peripapillary subretinal hemorrhage (PPSH), and to provide evidence-based guidance for diagnosis and management.
METHODS: Following PRISMA guidelines, PubMed, Web of Science, Elsevier, China National Knowledge Infrastructure (CNKI), and Wanfang were searched from inception to June 2026. Observational studies, case series, and case reports of IHAPSH, PPSH, or isolated optic disc hemorrhage were included. Data on demographics, anatomical features, precipitating factors, imaging findings, management, and outcomes were qualitatively synthesized.
RESULTS: Twenty-one studies involving 176 patients (181 eyes) were included. IHAPSH/PPSH predominantly affected young and middle-aged myopic Asian individuals. Myopia, small crowded optic discs, and optic disc tilt were consistently reported, suggesting they are the principal predisposing factors. In contrast, Valsalva-related triggers were infrequent, and vitreoretinal traction was rarely identified on imaging, arguing against either as the primary pathogenic mechanism. Across all evaluable eyes, myopia was present in 98.34%, small optic discs in 94.91%, optic disc tilt in 95.52%, identifiable Valsalva triggers in 12.78%, and vitreoretinal traction in 2.80%. The most common presentations were optic disc hemorrhage with peripapillary subretinal hemorrhage (40.80%) and hemorrhage with vitreous hemorrhage (36.20%), predominantly involving the nasal peripapillary region. Peripapillary hyperreflective ovoid mass-like structures (PHOMS) were frequently observed, whereas optic disc drusen were uncommon. The disease was typically unilateral, self-limiting, and associated with spontaneous hemorrhage resolution, favorable visual outcomes, and rare recurrence.
CONCLUSIONS: IHAPSH and PPSH are benign, self-limiting hemorrhagic disorders closely associated with myopia-related optic disc abnormalities and transient hemodynamic triggers. Myopia, crowded optic discs, and optic disc tilt appear to be the major predisposing factors. Recognition of their characteristic clinical and imaging features is essential for accurate diagnosis and avoidance of unnecessary interventions.
METHODS: Following PRISMA guidelines, PubMed, Web of Science, Elsevier, China National Knowledge Infrastructure (CNKI), and Wanfang were searched from inception to June 2026. Observational studies, case series, and case reports of IHAPSH, PPSH, or isolated optic disc hemorrhage were included. Data on demographics, anatomical features, precipitating factors, imaging findings, management, and outcomes were qualitatively synthesized.
RESULTS: Twenty-one studies involving 176 patients (181 eyes) were included. IHAPSH/PPSH predominantly affected young and middle-aged myopic Asian individuals. Myopia, small crowded optic discs, and optic disc tilt were consistently reported, suggesting they are the principal predisposing factors. In contrast, Valsalva-related triggers were infrequent, and vitreoretinal traction was rarely identified on imaging, arguing against either as the primary pathogenic mechanism. Across all evaluable eyes, myopia was present in 98.34%, small optic discs in 94.91%, optic disc tilt in 95.52%, identifiable Valsalva triggers in 12.78%, and vitreoretinal traction in 2.80%. The most common presentations were optic disc hemorrhage with peripapillary subretinal hemorrhage (40.80%) and hemorrhage with vitreous hemorrhage (36.20%), predominantly involving the nasal peripapillary region. Peripapillary hyperreflective ovoid mass-like structures (PHOMS) were frequently observed, whereas optic disc drusen were uncommon. The disease was typically unilateral, self-limiting, and associated with spontaneous hemorrhage resolution, favorable visual outcomes, and rare recurrence.
CONCLUSIONS: IHAPSH and PPSH are benign, self-limiting hemorrhagic disorders closely associated with myopia-related optic disc abnormalities and transient hemodynamic triggers. Myopia, crowded optic discs, and optic disc tilt appear to be the major predisposing factors. Recognition of their characteristic clinical and imaging features is essential for accurate diagnosis and avoidance of unnecessary interventions.