Clinical Challenge: Unusual Presentation of a Macular Hemorrhage Extending From the Internal Limiting Membrane to the Subretinal Space on Optical Coherence Tomography (OCT) in a Patient With Branch Retinal Vein Occlusion (BRVO)

Branch retinal vein occlusion (BRVO) is a common retinal vascular disorder typically characterized by distinct findings on fundus examination and optical coherence tomography (OCT). An unusual and challenging presentation involves a full-thickness macular hemorrhage extending from the internal limiting membrane (ILM) to the subretinal space. Here, we present the case of a 52-year-old male with type 2 diabetes mellitus who experienced sudden vision loss in the right eye and progressive vision decline in the left eye. Fundus examination revealed superotemporal BRVO in the right eye and old inferotemporal BRVO with extensive neovascularization in the left eye. OCT of the right eye showed a full-thickness hemorrhage from the ILM to the subretinal space, impacting the foveola and surrounding nasal perifoveal region. Fundus fluorescein angiography confirmed ischemic areas corresponding to BRVO. This rare presentation of macular hemorrhage complicates the management of BRVO and highlights the need for further research into the underlying pathological mechanisms and management strategies.