Rapid resolution of premacular haemorrhage after Nd:YAG laser posterior hyaloidotomy

Abstract

1 week after sudden, painless visual loss in the left eye. He had no systemic illness and no previous trauma, pain or redness in the left eye. Visual acuity (VA) was 6 ⁄ 6 in the right eye and hand movements (HM) in the left. Dilated fundal examination revealed a large preretinal haemorrhage about 10 disc diameters in size in the left eye, obscuring the macular area (Figs 1A, 2A). No source of haemorrhage such as proliferative diabetic retinopathy, macroaneurysm or choroidal neovascularization was found. The patient was treated with Nd:YAG laser posterior hyaloidotomy (VISULAS YAG11 plus; Zeiss). The beam was focused on the posterior hyaloid membrane and a single 7.4-mJ burst was used, after which the blood began to drain from the preretinal haemorrhage into the vitreous cavity (Figs 1B, 2B). Drainage of the blood into the vitreous cavity was completed within 10 mins and VA in the left eye improved dramatically from HM to 6 ⁄ 6 (Figs 1C, D and 2C, D). There were no complications as a result of the laser treatment. The blood in the vitreous resolved spontaneously over a period of 2 months and the patient was asymptomatic at the last followup visit. Premacular subhyaloid haemorrhage may be secondary to Valsalva retinopathy, proliferative diabetic retinopathy, central retinal vein occlusion, retinal macroaneurysm, Terson’s syndrome, blood dyscrasia and blunt ocular trauma (Raymond 1995; Ulbig et al. 1998; Celebi & Kukner 2001; Rennie et al. 2001). The haemorrhage usually resolves spontaneously and