History/Chief Complaint

  • A 56-year-old black female presented for follow-up for diabetic retinopathy, hypertensive retinopathy and glaucoma. She had undergone laser photo-coagulation in both eyes for proliferative diabetic retinopathy (PDR) and was taking alphagan and travatan for glaucoma.
  • She had a history of diabetes for 25 years but was unaware of her hypertension history. Even with an insulin pump, her hemoglobin A1c was 8.0. She complained of mild memory loss, reported having a stroke 6 years earlier and was being treated for high cholesterol levels.

Clinical Findings

  • VA OD 20/20- OS 20/25-
  • Ta= 20/20
  • Externals revealed arcus senilis OU and posterior chamber IOLs which were clear and centered.
  • A dilated fundus exam revealed a posterior staphyloma, retinal thinning due to previous high myopia, scattered laser burns OU and a new pre-retinal hemorrhage OD near the inferior arcades.

Topcon 3D OCT

  • The location and third dimensional extent of the hemorrhage revealed it to be under the posterior hyaloid. The “boat-shaped” hemorrhage with a flat top was verified with OCT.


  • Sub-hyaloid hemorrhage OD, due to either the diabetic retinopathy, the hypertensive retinopathy or both combined.


  • Additional laser photocoagulation and continue with the glaucoma drops. Careful follow-up with the patient’s internist.