Neodymium:YAG Laser Treatment for Hemorrhages under the Internal Limiting Membrane and Posterior Hyaloid Face in the Macula

Abstract

A dense premacular hemorrhage may occur from proliferative diabetic retinopathy, a ruptured retinal artery macroaneurysm, or Valsalva retinopathy. Spontaneous clearing of the hemorrhage in Valsalva retinopathy usually occurs, taking several months. In diabetic retinopathy, a traction macular detachment may result as early as 5 weeks after the hemorrhage. In diabetic retinopathy or a macroaneurysm, only a fibrotic epiretinal membrane overlying the macula may develop. Observation or vitrectomy is the current way of managing a dense premacular hemorrhage. This study was undertaken to investigate an alternative, neodymium:YAG (Nd:YAG) laser membranotomy, in treating this type of hemorrhage. Six eyes in six patients had Q-switched Nd:YAG laser treatment to open trapped hemorrhage overlying the macula. One to three laser membranotomies were performed. Colored fundus photographs were obtained before and after the hemorrhage was treated. In some cases, fluorescein angiography was done before the hemorrhage was treated. The size of the pretreated hemorrhage was estimated from the photographs and expressed in disc diameters. Patients with diabetes had panretinal laser before Nd:YAG laser membranotomy. The premacular bleeding originated from proliferative diabetic retinopathy in four eyes and from a retinal artery macroaneurysm in two. Average estimated area of the pretreated hemorrhage was 14 disc diameters. Five eyes had marked clearing of hemorrhage and rapid improvement of vision after Nd:YAG laser membranotomy. Average follow-up after laser treatment was 20 months. One diabetic eye required vitrectomy for rebleeding. One eye had little visual improvement due to pre-existing subretinal bleeding. Neodymium:YAG laser membranotomy seems helpful in rapid clearing of premacular hemorrhage in certain eyes. A randomized prospective study is needed to evaluate observation, vitrectomy, and Nd:YAG laser treatment of dense premacular hemorrhage.