Papilledema related to idiopathic intracranial hypertension (IIH) may present with optic disc hemorrhaging. The significance and characteristics of these hemorrhages still remains to be clarified. Here, we present 2 unique cases with severe unilateral optic disc hemorrhaging in all 3 retinal layers (preretinal, intraretinal, and subretinal) and a good visual outcome. A 42- and a 44-year-old woman presented with signs and symptoms of raised intracranial pressure. Visual acuity was normal and Humphrey visual field testing showed only mild vision loss with enlarged blind spots. Dilated fundus examination revealed moderate papilledema in both eyes with severe optic disc hemorrhaging in the left eye in the first patient and the right eye in the second patient. The optic disc hemorrhaging occurred in all 3 retinal layers (preretinal, intraretinal, and subretinal), and the fellow eyes had only minimal hemorrhage. All patients had normal magnetic resonance imaging/magnetic resonance venography, and lumbar punctures revealed elevated opening pressures and normal cerebrospinal fluid contents. The papilledema resolved after 4 months in both cases with medical therapy. Optic disc hemorrhaging may be severe in patients with IIH, but this does not necessarily confer a poor visual outcome. The differential diagnosis of hemorrhages in all 3 retinal layers may be expanded to include IIH.
Case Rep Ophthalmol 2021;12:616–621

中文翻译：

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特发性颅内高压患者的三层视盘出血

与特发性颅内高压 (IIH) 相关的视乳头水肿可能表现为视盘出血。这些出血的意义和特征仍有待阐明。在这里，我们介绍了 2 个独特的病例，在所有 3 个视网膜层（视网膜前、视网膜内和视网膜下）均出现严重的单侧视盘出血，并且视觉效果良好。一名 42 岁和 44 岁女性出现颅内压升高的体征和症状。视力正常，汉弗莱视野测试仅显示轻度视力丧失，盲点扩大。散瞳眼底检查显示双眼中度视乳头水肿，第一个患者的左眼和第二个患者的右眼有严重的视盘出血。视盘出血发生在所有 3 个视网膜层（视网膜前、视网膜内、和视网膜下），对侧眼睛仅有少量出血。所有患者的磁共振成像/磁共振静脉造影均正常，腰椎穿刺显示开放压力升高，脑脊液含量正常。两例药物治疗 4 个月后视乳头水肿消退。IIH 患者的视盘出血可能很严重，但这并不一定会导致不良的视力结果。所有 3 层视网膜出血的鉴别诊断可以扩大到包括 IIH。IIH 患者的视盘出血可能很严重，但这并不一定会导致不良的视力结果。所有 3 层视网膜出血的鉴别诊断可以扩大到包括 IIH。IIH 患者的视盘出血可能很严重，但这并不一定会导致不良的视力结果。所有 3 层视网膜出血的鉴别诊断可以扩大到包括 IIH。
Case Rep Ophthalmol 2021；12:616–621