Salmon-Patch Hemorrhages After Central Retinal Artery Occlusion in Sickle Cell Disease

Abstract

• In two patients with sickle cell disease (one hemoglobin SC and one hemoglobin SS), central retinal artery occlusions developed. In one case, the occlusion followed a retrobulbar injection of lidocaine hydrochloride. Although the central retinal artery reperfused in each patient, many secondary peripheral retinal arteriolar occlusions remained. During the subsequent days, multiple salmon-patch hemorrhages developed in the distribution of these occluded arterioles. In one patient, the salmon-patch hemorrhages evolved into atrophic schisis cavities. These unusual cases allowed us to document the origin of salmon-patch hemorrhages after peripheral retinal arteriolar occlusions. The development of the hemorrhages was a delayed phenomenon that occurred hours to days after the initial vascular occlusion. Reperfusion of the damaged ischemic vessels with a blowout of the wall of the vessels seems the most likely explanation for this phenomenon.