Recurrent vitreous haemorrhage from sporadic retinal astrocytic hamartoma.

This paper describes the case of a 25-year-old white male presented in 2005 as an emergency with floaters and decreased visual acuity in the right eye who had recurrent vitreous hemorrhage. His past ocular history was positive for unexplained juxtapapillary retinal oedema and vitreous haemorrhage in 1996 with spontaneous resolution. Systemic and family history was negative. Fundus examination showed a circumscribed yellow white juxtapapillary retinal lesion along the superotemporal arcade with vitreous haemorrhage arising from the lesion. Our final diagnosis was sporadic retinal epipapillary astrocytic hamartoma with recurrent vitreous haemorrhage. Vitreous haemorrhage in retinal astrocytic hamartoma is unusual and has been reported previously only in the context of tuberous sclerosis. Our case suggests a vascular component exists in sporadic retinal astrocytic hamartoma. Retinal astrocytic hamartomas of tuberous sclerosis have been classified into three types by angiographic features: all three types block choroidal fluorescence to some extent and show late leakage on FA, but on ICG type 1 has subtle blockage of choroidal fluorescence, type 2 has total blockage (from calcification) and type 3 has total blockage only in the centre. Though our case is sporadic, it has features of type 1 on FA and type 2 on ICG, suggesting incomplete calcification. OCT features are also consistent with retinal astrocytic hamartoma. We believe that sporadic retinal astrocytic hamartoma should now be included in the differential diagnosis of recurrent vitreous haemorrhage – sporadic cases can exhibit vasculopathic features.