Objective: To describe a patient with vitreous hemorrhage due to peripheral retinal ischemia and neovascularization, who was diagnosed with an underlying retinal arteriovenous malformation.

Methods: A 15-year old girl presented with sudden-onset painless visual loss in the right eye. She underwent a full ophthalmologic work-up.

Results: BCVA was less than 20/400 in the right eye, 20/20 in the left eye. Intraocular pressure and anterior segment examination were unremarkable. Fundoscopy revealed an impenetrable vitreous hemorrhage in the right eye. The left eye was completely unremarkable. Examination during a 23-gauge pars plana vitrectomy showed dilated, tortuous arteriovenous vessels extending from the optic disc and peripheral neovascularization. A clinical diagnosis of retinal arteriovenous malformation was made. During surgery, a peripheral retinal photocoagulation was completed to avoid rebleeding. During the post-operative period, a fluorescein angiography demonstrated additional macular microangiopathy and diffuse retinal nonperfusion in the periphery. MRI brain revealed no cerebral or orbital vascular anomaly, confirming a retinal arteriovenous malformation group 1.

Conclusion: Retinal arteriovenous malformations are thought of to be stable over time. However complications such as ischemia, neovascularization and vitreous hemorrhage might occur. Observation is warranted.  As such, timely treatment can be offered to avoid complications.

Data was collected by full ophthalmologic work-up using ultrasonography, fluoangiography and OCT of the macula