Peri-papillary vascular loops (PVL) are rare congenital vascular malformations, which are usually detected as accidental finding during routine fundus examination. They can often be confused with tributary vein occlusion or racemose hemangioma. Although benign and asymptomatic, they can be rarely associated with vitreous hemorrhage and arterial occlusion. We herein present a case of a 60-year-old hypertensive male, who was diagnosed elsewhere to have a tributary vein occlusion and was referred to us. FFA was advised to rule out neovascularization, surrounding capillary non perfusion and mass lesion (hemangioma). On FFA, the arterial loop showed a slightly delayed filling (3-5 seconds) as compared to the other arterial vessels and the original vessel appeared to be a branch arising from central retinal artery. The choroidal filling was delayed in the area supplied by the loop. A cilioretinal artery was also noted. The patient was diagnosed to have a Peri-papillary vascular arterial loop (PVL), likely to be congenital in origin. The patient was reassured and was advised yearly follow up. These loops are usually accidental findings discovered during routine fundus examination. Since these vessels are looped and tortuous, they exhibit a slower and laminar blood flow, which make them more prone for arterial occlusions. The vitreous in this area tends to be adherently attached, so during PVD induction, it is likely to cause a tear and hemorrhage leading to vitreous hemorrhage. Until and unless there is a break, this hemorrhage tends to resolve on its own and does not warrant treatment. If there is an evident break, it can be dealt with laser barrage.
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