Unmasking a Silent Persistent Hyaloid Artery: A Rare Cause of Vitreous Hemorrhage in an Elderly Patient

Persistent hyaloid artery (PHA) rupture is a rare cause of vitreous hemorrhage, particularly in older adults, as hyaloid remnants typically regress during early life. We report the case of a 70-year-old man who presented with sudden, painless vision loss in the left eye due to dense vitreous hemorrhage. Immediate pars plana vitrectomy was performed, during which an actively bleeding PHA was identified and successfully cauterized. Intraoperative video documentation provided direct visualization of the ruptured embryonic vessel, confirming the diagnosis. No retinal tears, retinal detachment, or neovascularization were noted. Postoperatively, the patient experienced progressive visual recovery, ultimately returning to his baseline visual acuity. This case expands the known age spectrum of symptomatic PHA, demonstrates the diagnostic and therapeutic value of early vitrectomy in non-clearing hemorrhage, and underscores the importance of considering congenital vascular remnants in the differential diagnosis of spontaneous vitreous hemorrhage in elderly patients.