Abstract
Purpose Premacular subhyaloid haemorrhage produces sudden, profound visual loss which may be prolonged if untreated. Nd:YAG laser treatment can create a posterior hyaloidotomy enabling rapid diffusion of subhyaloid haemorrhage into the vitreous gel. This study was performed to assess the results of Nd:YAG laser hyaloidotomy and to compare the outcome with similar conservatively managed cases.
Methods Nd:YAG laser hyaloidotomy was performed in 6 patients with premacular subhyaloid haemorrhage. The aetiologies were Valsalva retinopathy, macroaneurysm, branch retinal vein occlusion, proliferative diabetic retinopathy (2 cases) and idiopathic. Four patients with premacular subhyaloid haemorrhage were managed conservatively. The aetiologies were Valsalva retinopathy (2 cases), macroaneurysm and proliferative diabetic retinopathy.
Results Nd:YAG laser hyaloidotomy achieved rapid resolution of subhyaloid haemorrhage in all treated patients. Visual acuity improved to 6/9 or better in 4 patients, but was limited by ischaemic diabetic retinopathy in 2 patients. No patient had evidence of damage to the retina or choroid from treatment. Among the conservatively managed cases, 3 patients had slow resolution of the subhyaloid haemorrhage over 3-6 months. One patient with diabetic retinopathy demonstrated little improvement at 18 months.
Conclusion Nd:YAG laser hyaloidotomy is a safe and effective procedure. It achieves rapid resolution of premacular subhyaloid haemorrhage with restoration of visual function, preventing the need for vitreoretinal surgery.
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References
Gass JDM . Stereoscopic atlas of macular diseases: diagnosis and treatment, 3rd ed. St Louis: CV Mosby, 1987:362, 564.
O'Hanley GP, Canny CLB . Diabetic dense premacular hemorrhage: a possible indication for prompt vitrectomy. Ophthalmology 1985;92:507–11.
Clearly PE, Kohner EM, Hamilton AM, Bird AC . Retinal macroaneurysms. Br J Ophthalmol 1975;59:355–61.
Brent BD, Gonce M, Diamond JG . Pars plana vitrectomy for complications of retinal arterial macroaneursysms: a case series. Ophthalmic Surg 1993;24:534–6.
Raymond LA . Neodymium:YAG laser treatment for hemorrhages under the internal limiting membrane and posterior hyaloid face at the macula. Ophthalmology 1995;102:406–11.
Isaacs TW, Barry C, McAllister IL . Early resolution of premacular haemorrhage following Nd:YAG laser photodisruption of posterior hyaloid. Aust N Z J Ophthalmol 1996;24:365–7.
Gabel V-P, Birngruber R, Gunther-Koszka H, Puliafito CA . Nd:YAG laser photodisruption of hemorrhagic detachment of the internal limiting membrane. Am J Ophthalmol 1989;107:33–7.
Tassignon MJ, Stempels N, Van Mulders L . Retrohyaloid premacular haemorrhage treated by Q-switched Nd:YAG laser: a case report. Graefes Arch Clin Exp Ophthalmol 1989;227:440–2.
Stempels N, Tassignon MJ, Worst J . Les hémorrhagies dans la bourse prémaculaire traitées par le Q-switched Nd:YAG laser. Ophtalmologie 1990;4:314–6.
Iijima H, Satoh S, Tsukahara S . Nd:YAG laser photodisruption for preretinal hemorrhage due to retinal macroaneurysm. Retina 1988;18:430–4.
Ezra E, Dowler JGF, Burgess F, Sehmi K, Hamilton PA . Identifying maculopathy after neodymium:YAG membranotomy for dense diabetic premacular haemorrhage. Ophthalmology 1996;103:1568–74.
Chau P, Reich JA . Use of the neodymium-YAG laser to manage subinternal limiting membrane haemorrhage. Aust N Z J Ophthalmol 1991;19:81–3.
Ulbig MW, Mangouritsas G, Rothbacher HH, Hamilton AMP, McHugh JD . Long-term results after drainage of premacular subhyaloid hemorrhage into the vitreous with a pulsed Nd:YAG laser. Arch Ophthalmol 1998;116:1465–9.
Frankhauser F, Kwasniewska S . Neodymium:yttrium-aluminium-garnet laser. In: L'Esperance FA, editor. Ophthalmic lasers, vol II. St Louis: CV Mosby, 1989.
Woon WH, Ffytche TJ, Hamilton AMP, Marshall J . Iris clipping of a diode laser beam when performing retinal photocoagulation. Br J Ophthalmol 1991;75:386–90.
Puliafito CA, Wasson PJ, Steinert RF, Gragoudas ES . Neodymium YAG laser surgery on experimental vitreous membranes. Arch Ophthalmol 1984;102:843–7.
Thach AB, Lopez PF, Snady-McCoy LC, Golub BM, Frambach DA . Accidental NdYAG laser injuries to the macula. Am J Ophthalmol 1995;119:767–73.
Duane TD . Valsalva hemorrhagic retinopathy. Trans Am Ophthalmol Soc 1972;70:298–313.
Duane TD . Valsalva hemorrhagic retinopathy. Am J Ophthalmol 1973;75:637–42.
Palestine AG, Robertson DM, Goldstein BG . Macroaneurysms of the retinal arteries. Am J Ophthalmol 1982;93:164–71.
Berrocal MH, Lewis ML, Flynn HW . Variations in the clinical course of submacular hemorrhage. Am J Ophthalmol 1996;122:486–93.
Michels RG . Proliferative diabetic retinopathy: pathophysiology of extraretinal complications and principles of vitreous surgery. Retina 1981;1:1–17.
Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report 2. Ophthalmology 1987;94:761–74.
The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy: four year results of a randomised trial: Diabetic Retinopathy Study Report 5. Arch Ophthalmol 1990;108:958–64.
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Presented as a poster at the Royal College of Ophthalmologists Annual Congress, May 1999
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Rennie, C., Newman, D., Snead, M. et al. Nd:YAG laser treatment for premacular subhyaloid haemorrhage. Eye 15, 519–524 (2001). https://doi.org/10.1038/eye.2001.166
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DOI: https://doi.org/10.1038/eye.2001.166
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