Krypton laser membranotomy in the treatment of dense premacular hemorrhage

Abstract

Background: Neodymium:YAG (Nd:YAG) laser and argon laser membranotomy have been used in patients with premacular hemorrhage to drain premacular blood into the vitreous cavity and rapidly clear the hemorrhage. However, the Nd:YAG laser appears to be difficult to use, and argon laser energy may be more likely to be absorbed by the ocular media. We performed a study to evaluate the safety and effectiveness of krypton laser membranotomy in selected cases of premacular hemorrhage.Methods: Sixteen patients (17 eyes) with dense premacular hemorrhage for 2 weeks or less were enrolled from April 1998 to February 2004.The causes of premacular hemorrhage were proliferative diabetic retinopathy (PDR) in 12 eyes, Valsalva retinopathy in 3 eyes, leukemia in 1 eye and retinal arterial macroaneurysm in 1 eye. Krypton laser was used to create a membranotomy on the sloping edge of the premacular hemorrhage. Five eyes with PDR were treated with inferior panretinal photocoagulation and laser membranotomy simultaneously. After intravitreal dispersion of premacular blood, fundus examination was performed in all eyes and fluorescein angiography in five eyes to evaluate retinal damage.Results: All eyes had visual improvement within 2 weeks postoperatively. No retinal damage was seen at the site of membranotomy in any eye. No eye needed vitrectomy postoperatively during a mean follow-up duration of 18.6 months.Interpretation: Krypton laser membranotomy appears to be a safe and simple alternative procedure for treating selected cases of premacular hemorrhage. Further trials are necessary to evaluate its benefit.