Spontaneous retrobulbar hemorrhage in the setting of warfarin therapy and latent scurvy diagnosis.

We present a case of spontaneous nontraumatic retrobulbar hemorrhage associated with anti-coagulation therapy and a new diagnosis of scurvy. A 68-year-old male on chronic anti-coagulation therapy presented with a retrobulbar hemorrhage requiring urgent canthotomy and cantholysis. Despite the absence of a supratherapeutic INR and normal clotting factors, the patient continued to have spontaneous hemorrhages within the orbit and elsewhere. Workup revealed a severe vitamin C deficiency consistent with scurvy. Further investigation of dietary history demonstrated an avoidance of all citrus fruit upon starting warfarin due to misunderstanding in medication counseling on avoidance of grapefruit. With repletion of vitamin C and further medication counseling, the patient had no further episodes of spontaneous hemorrhage.

Solitary retinal hemangioblastoma findings in OCTA pre- and post-laser therapy.

PURPOSE: To report optical coherence tomography angiography (OCTA) findings pre- and post-thermal laser therapy of a rare, asymptomatic, unilateral, isolated retinal hemangioblastoma. OBSERVATIONS: A 40-year-old asymptomatic Caucasian man was found to have an isolated, unilateral retinal hemangioblastoma after referral for possible retinal hole. Comparison of OCTAs pre- and post-thermal laser therapy demonstrated a significant reduction of blood flow toward and within the lesion, in addition to contraction of the lesion and constriction of the accompanying feeder vessels. A 4-month follow-up OCTA showed marked reduction of lesion size, and caliber of treated vessels. CONCLUSIONS AND IMPORTANCE: Non-invasive OCTA imaging of a retinal hemangioblastoma demonstrated decreased blood flow signal and vessel caliber after treatment. OCTA shows potential as a new tool to improve our understanding of the effectiveness of therapy in these lesions.