Photo Essay Edited by Cynthia A. Toth with Sumit Sharma and Dilraj S. Grewal Novel Outer Retinal Optical Coherence Tomography Hyperreflective Abnormality Associated With Sub–Internal Limiting Membrane Hemorrhage P remacular hemorrhages occur in a number of sys- temic or local ocular conditions 1,2 and can be located at the subhyaloidal or sub–internal limiting membrane (ILM) space. Accurate diagnosis of hemorrhage location can be difficult based on fundus examination alone but is important particularly when surgery is indicated and can be improved using optical coherence tomography (OCT). 2,3 In this article, we describe a new OCT finding of sub-ILM hemorrhage. A 40-year-old man referred a 1-month history of acute visual loss in the right eye. Fundus examination disclosed a dome-shaped premacular hemorrhage demarcated by a yellow line at the lesion’s border, and OCT revealed blood collection between the ILM Fig. 1. A. Fundus photograph (left) showing a dome-shaped premacular hemorrhage. Note a well-demarcated yellow line (small white arrows) at the bor- der of the lesion. Optical coher- ence tomography (right) reveals incomplete posterior hyaloid detachment (yellow arrowhead), blood between ILM and retinal nerve fiber layer, and an hyper- reflective image above RPE corresponding to the yellow line (yellow arrows). B and C. Fun- dus photograph (left) and OCT findings (right) after 1-month (B) and 3-month (C) follow-up examinations. D. Fundus pho- tograph (left) and OCT (right) of another patient with sub- hyaloidal hemorrhage. Note the absence of the yellow line sign and the outer retinal OCT abnormalities described above (A–C). From the Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil. None of the authors have any financial/conflicting interests to disclose. Reprint requests: Ana Claudia F. Suzuki, MD, Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil; e-mail: anacsuzuki@gmail.com 1713