De novo blood within Haab's Striae in congenital glaucoma

Abstract

A 7-year-old boy, diagnosed with bilateral congenital glaucoma presented with elevated intraocular pressure (IOP). Anterior segment optical coherence tomography (AS-OCT) of the right eye revealed an artificial plane within the Haab's striae (HS), corresponding to separation of the Descemet membrane—pre-Descemet layer (DM—PDL) complex. Following medical reduction of IOP, slit-lamp examination demonstrated linear reddish discoloration within the HS, which was confirmed on AS-OCT as a hyperreflective intra-lamellar collection of blood between the posterior stroma and endothelium. The eye had not undergone any previous intraocular surgery or trauma. This observation represents a unique instance of de novo intra-lamellar hemorrhage within Haab's striae in an unoperated eye. The presumed mechanism involves reflux of blood into Schlemm's canal, with secondary ingress into the artificial plane created by partial DM–PDL separation, possibly triggered by a Valsalva maneuvre combined with low IOP. This finding underscores the potential anatomical continuity between the PDL and the trabecular meshwork, as previously demonstrated histologically. Recognition of this phenomenon is important to distinguish it from postoperative endothelial hemorrhage or corneal blood staining and to expand our understanding of corneal structural responses in congenital glaucoma. To our knowledge, this is the first reported case demonstrating intra-lamellar bleeding within a pre-existing Haab's striae, documented non-invasively using high-resolution AS-OCT.