Massive Retinal Hemorrhage during Epiretinal Membrane Peeling in Patient with Iron Deficiency Anemia

ABSTRACT

Purpose@#To report a case of massive retinal hemorrhage during epiretinal membrane (ERM) peeling in a patient with iron deficiency anemia (IDA).Case summary: A 59-year-old female presented with gradually decreasing visual acuity and dysmorphopsia in the right eye for several months. She had a history of chronic IDA due to subtotal gastrectomy from gastric cancer 20 years prior. The patient was diagnosed as having macular ERM and underwent vitrectomy. During ERM peeling with intraocular forceps, we found a massive retinal hemorrhage which was presumed to have originated from the superotemporal branched retinal artery. After hemostasis, the operation was completed without critical complications. However, 2 months after surgery, the patient presented with decreased visual acuity once again. In fundus examination, diffuse macular tractional ERM was evident in the proximity of the previous intraoperative hemorrhage site. The patient underwent tractional membrane and internal limiting membrane removal surgery. The patient is currently undergoing follow-up without complications to date following the second surgery. @*Conclusions@#Our case study describes a patient having experienced massive retinal hemorrhage presumably having originated from a superotemporal branched retinal artery during ERM peeling. We speculate that the endothelial cells of retinal vessels are more vulnerable than normal in patients with severe chronic IDA.