Abstract
BackgroundPremacular subhyaloid hemorrhage results in a sudden profound loss of vision. Among the modalities for its treatment, Nd:YAG laser hyaloidotomy is a non invasive method enabling rapid drainage of the obstructed macular area and improved vision within days. This study was aimed to evaluate the efficacy, visual outcome and complications following Nd:YAG laser hyaloidotomy for premacular subhyaloid hemorrhage.MethodsPatients with premacular subhyaloid hemorrhage of more than 3 disc diameters (DD) of various etiologies, attending Tilganga Institute of Ophthalmology, Nepal from August, 2014 to February, 2015, were included. A comprehensive ocular evaluation was conducted and fundus photographs were taken to measure the size of the subhyaloid hemorrhage. Optical coherence tomography (OCT) were performed before and after treatment and on subsequent follow up visits. Fundus fluorescence angiography was done whenever necessary. Q switched Nd:YAG laser was applied to create an opening in the posterior hyaloids membrane for draining subhyaloid hemorrhage. The main outcome measures were success rate in performing hyaloidotomy, drainage of subhyaloid blood into vitreous cavity and its resorption, improvement in visual acuity, need for further intervention and postoperative complications.ResultsThere were 21 eyes of 19 patients, 17(89.48 %) male and 2(10.52 %) female. In 3, premacular subhyaloid hemorrhage was bilateral. Mean age was 41.68 ± 17.08 years and a mean duration of symptoms 15.04 days. Mean pretreatment hemorrhage was 6.27DD. Nd:YAG laser hyaloidotomy was successful in 19 eyes(86.4 %). In 2 patients, one each with Eales’ disease and retinal vein occlusion the procedure was unsuccessful, necessitating pars plana vitrectomy, while in a case with proliferative diabetic retinopathy (PDR), vitrectomy was resorted for non clearing vitreous hemorrhage. Vision improved from a median of 3/60 pre-operatively to 6/6, at 6 months follow up. At 3 months, 2 patients with Eales’ disease, one developed tractional detachment at macula while the other, an epiretinal membrane. No other complications were noted at 6 months.ConclusionNd:YAG laser hyaloidotomy is an inexpensive, effective and a safe outpatient procedure for premacular subhyaloid hemorrhage, producing rapid drainage with restoration of visual function avoiding more invasive procedures and enabling early assessment of the underlying retina. The final visual prognosis however, rests on the underlying cause of the subhyaloid hemorrhage and any accompanying retinal changes.
Highlights
Premacular subhyaloid hemorrhage results in a sudden profound loss of vision
Subhyaloid premacular hemorrhage is typically characterized by a circumscribed, round or dumb-bell shaped, bright red mound of blood beneath the internal limiting membrane (ILM) or between the ILM and hyaloid face, in or near to the central macular area [2, 3]. It may occur in retinal vascular disorders, such as proliferative diabetic retinopathy [4], retinal vein occlusion [5], macroaneurysm [4], age-related macular degeneration [5] and arterio-venous communication of the retina; [6] hematological disorders as aplastic anemia and leukemia; [7] following laser in situ keratomileusis (LASIK); [8] or after retinal vascular rupture associated with physical exertion [2, 9,10,11], Terson’s syndrome [12] and Purtscher’s retinopathy [13]
We describe the etiologies, patient characteristics and outcome of Nd:YAG laser hyaloidotomy in 22 eyes of 19 patients presenting with premacular subhyaloid hemorrhage
Summary
Premacular subhyaloid hemorrhage results in a sudden profound loss of vision. Among the modalities for its treatment, Nd:YAG laser hyaloidotomy is a non invasive method enabling rapid drainage of the obstructed macular area and improved vision within days. Subhyaloid premacular hemorrhage is typically characterized by a circumscribed, round or dumb-bell shaped, bright red mound of blood beneath the internal limiting membrane (ILM) or between the ILM and hyaloid face, in or near to the central macular area [2, 3] It may occur in retinal vascular disorders, such as proliferative diabetic retinopathy [4], retinal vein occlusion [5], macroaneurysm [4], age-related macular degeneration [5] and arterio-venous communication of the retina; [6] hematological disorders as aplastic anemia and leukemia; [7] following laser in situ keratomileusis (LASIK); [8] or after retinal vascular rupture associated with physical exertion (valsalva) [2, 9,10,11], Terson’s syndrome [12] and Purtscher’s retinopathy [13]. It may result in permanent visual impairment due to pigmentary macular changes or formation of epiretinal membranes and toxic damage to the retina due to prolonged contact with hemoglobin and Iron [14]
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