Vitrectomy for premacular hemorrhagic cyst in children and young adults

Abstract

A pre-macular accumulation of blood is termed a hemorrhagic macular cyst and may be found both in eyes with Terson's syndrome and in shaken baby syndrome. In this study, we report on our experience and results of vitreoretinal surgery for treatment of pre-macular hemorrhagic cyst in eyes of patients suffering from Terson's syndrome and shaken baby syndrome. Between November 1995 and May 2003 seven eyes of six children underwent vitrectomy for pre-macular hemorrhagic cyst. Patients' age ranged from 5 months to 17 years. Indication for vitreoretinal surgery was pre-macular hemorrhagic cyst in eyes with Terson's syndrome (n=5) and shaken baby syndrome (n=2). During vitrectomy, rhexis of internal limiting membrane was performed. Four children received intensive orthoptic treatment postoperatively. All eyes in our series showed a submembranous localization of pre-macular hemorrhagic cyst. The results of electron microscopic examination showed that the excised anterior walls contain internal limiting membrane. In all eyes improvement of the anatomic situation and of visual acuity was achieved. Duration of follow-up ranged from 6 months to 5 years. Vitrectomy for hemorrhagic macular cyst in children is a safe and effective alternative to observation, offering visual rehabilitation, especially if amblyopia has developed or if both eyes are affected. If a hemorrhagic macular cyst is encountered, its complete removal is recommended to prevent development of proliferative vitreoretinopathy.