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“Hematocrit Sign” in PEVAC Lesion

Venkatesh, Ramesh MS; Pereira, Arpitha DNB, MRCS(Ed); Sridharan, Akhila DO, DNB

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Asia-Pacific Journal of Ophthalmology: March-April 2021 - Volume 10 - Issue 2 - p 224-225
doi: 10.1097/APO.0000000000000385
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A 68-year-old lady with no history of any known systemic disease like diabetes or hypertension visited a tertiary eye care hospital for regular check-up. She had a posterior chamber intraocular lens in her left eye (LE). Her vision was 20/20, N6 and 20/30, N8 in right eye (RE) and LE respectively. Anterior segment examination was normal. The RE fundus was normal. The LE fundus showed a couple of large perifoveal microaneurysms with surrounding intraretinal fluid. A clinical diagnosis of perifoveal exudative vascular anomalous complex (PEVAC) was made. Multimodal imaging with multicolor imaging, optical coherence tomography (OCT), fluorescein and indocyanine green angiography, and enface OCT was done. The images in Figures 1 and 2 confirmed the clinical diagnosis of PEVAC. Laser photocoagulation to the lesions was performed without any success.

Multimodal imaging of the left eye showing the “horizontal fluid level” in PEVAC: A and B, Late phase fluorescein angiography (FA) and indocyanine green angiography (ICGA) shows well-defined hyperfluorescent lesions with surrounding leakage on FA (white arrows) and none on ICGA (black arrows) suggestive of PEVAC lesions. C, Optical coherence tomography (OCT) image through the aneurysm shows a round structure (white arrow) with hyperreflective wall and blood-filled lumen with surrounding intraretinal cystic spaces. D, Enface OCT image shows the aneurysm as an isolated large oval retinal dilation in the deep capillary plexus. A horizontal level is noted within the lesion due to the separation of the blood into its corpuscular and serous components which we describe as the “hematocrit sign” (black arrow).
Multicolour image of the left eye showing the PEVAC lesions: Multicolour image using Spectralis Heidelberg of the left eye shows large perifoveal microaneurysms with few hard exudates (white arrows).


Aneurysmal lesions arising from the retinal/choroidal vasculature include retinal artery macroaneurysm, polypoidal choroidal vasculopathy (PCV), microaneurysms, MacTel Type 1, and PEVAC.1,2 These lesions have hyperreflective walls and a clear or blood-filled lumen. “Haematocrit sign” in PCV was described on enface OCT images as round polyp with blood corpuscles sedimented inferiorly giving rise to a horizontal fluid level within the polyp.1 In this image, enface OCT scans showed similar “horizontal fluid level” within the aneurysmal PEVAC lesion. To our knowledge, “hematocrit sign” in PEVAC has not been documented in the literature.


1. Imamura Y, Engelbert M, Iida T, et al. Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol 2010; 55:501–515.
2. Sacconi R, Freund KB, Yannuzzi LA, et al. The expanded spectrum of perifoveal exudative vascular anomalous complex. Am J Ophthalmol 2017; 184:137–146.
Copyright © 2021 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.