Limiting Membrane Hemorrhage Research Articles

Photoreceptor Damage in Terson Syndrome.

To describe photoreceptor damage in patients with Terson syndrome as a potential cause for inconsistent clinical outcomes. Clinical evaluation and retinal imaging in six patients. Four patients were female and two male, with an average age of 46.8 years (SD 8.9). Four patients suffered aneurysmal subarachnoid haemorrhage, one vertebral artery dissection, and one superior sagittal sinus thrombosis. In 11 eyes, we observed a consistent pattern of outer retinal damage within the central macula affecting the ellipsoid zone and the outer nuclear layer, indicating photoreceptor damage. Areas of photoreceptor damage showed poor spatial correlation with intraocular haemorrhage, particularly sub-internal limiting membrane haemorrhage. The observed retinal abnormalities demonstrated incomplete recovery over long-term follow-up 3.5 to 8 years post-haemorrhage, irrespective of surgical or conservative treatment strategy, and had variable impact on the patients' visual function. The observations suggest that photoreceptor damage in Terson syndrome likely represents a distinct manifestation of this condition, which could be caused by transient ischaemia resulting from disturbed choroidal perfusion secondary to acute rise in intracranial pressure.

Removal of Sub-Internal Limiting Membrane Hemorrhage Secondary to Retinal Arterial Macroaneurysm Rupture: Internal Limiting Membrane Non-Peeling Technique.

The appropriate surgical technique to improve the closure rate of perioperative full-thickness macular hole (FTMH) secondary to submacular hemorrhage (SMH) with sub-internal limiting membrane (ILM) hemorrhage caused by retinal arterial macroaneurysm (RAM) rupture remains an unsolved clinical problem. Several ILM transplantation techniques have been attempted, but these are challenging. Our new technique can remove sub-ILM hemorrhage with the central fovea ILM intact, without peeling the ILM. The medical records of three eyes from three patients with SMH and sub-ILM hemorrhage secondary to RAM rupture were retrospectively reviewed. During the surgery, a small ILM fissure was made outside the central fovea with ILM forceps, and sub-ILM hemorrhage was washed out through it by manually spraying balanced salt solution. Sub-ILM hemorrhage removal was achieved successfully in all eyes, with no occurrences of FTMH or other complications. Best-corrected decimal visual acuity improved from 0.05 (Snellen equivalent (SE), 20/400), 0.05 (SE, 20/400), and 0.05 (SE, 20/400) preoperatively to 0.3 (SE, 20/63), 0.4 (SE, 20/50), and 0.15 (SE, 20/125) at 3 months postoperatively, respectively. This new technique may help keep the foveal ILM intact and prevent perioperative FTMH formation.

Sub-inner limiting membrane haemorrhage successfully treated with pars plana vitrectomy – case report

Sub-inner limiting membrane haemorrhage successfully treated with pars plana vitrectomy – case report

Green Laser Pointer–Induced Subinternal Limiting Membrane Hemorrhage

Green Laser Pointer–Induced Subinternal Limiting Membrane Hemorrhage

Retinal arterial macroaneurysm rupture by Valsalva maneuver: a case report and literature review

BackgroundRetinal artery macroaneurysms (RAMs) are focal dilations of the large retinal arteries. Most RAMs are asymptomatic, however, when hemorrhage or exudation caused by a RAM involves the macula, patients can experience marked vision loss. This article reported a rare case of a ruptured RAM due to the Valsalva maneuver in an elderly female with constipation and offered a review of the relevant literature.Case presentationA 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained "on its own" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient's vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole.ConclusionsThis is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.

Optical coherent tomography angiography observation of macular subinternal limiting membrane hemorrhage in CO poisoning: a case report.

Optical coherent tomography angiography observation of macular subinternal limiting membrane hemorrhage in CO poisoning: a case report.

Traumatic Maculopathies Associated with Closed-Globe Injury

Traumatic maculopathies due to closed-globe injury are commotio retinae (Berlin’s edema), choroidal rupture, traumatic macular hole, retinitis sclopetaria, shaken baby syndrome, Valsalva retinopathy, and Purtscher retinopathy. The main pathology in commotio retinae is in the outer retinal layers and usually resolves spontaneously. Blunt eye traumas coming from the anterior aspect can cause choroidal ruptures. These are mainly due to the rupture of inelastic Bruch membrane and adjacent structures. If they involve fovea, visual loss can occur. Late choroidal neovascularisation may develop in 1/10 of the cases. Traumatic macular holes develop in less than 2% of the blunt ocular traumas. Early macular holes result from tangential traction whereas late holes from anteroposterior vitreoretinal traction. They can be closed spontaneously within 4 months, especially in young patients. Retinitis sclopetaria is rare. It results from high-velocity pellets that hit but do not penetrate the globe. Shock waves can cause the rupture of the choroid and overlie the neurosensory retina. The shaken baby syndrome is a result of the violence in the family. It must be reported to the police. Retinal hemorrhages, cotton wool spots, and hemorrhagic retinoschisis areas are the prominent features. The sudden increase in intrathoracic or abdominal pressure may lead to the rupture of the retinal capillaries and usually a sub-internal limiting membrane hemorrhage in Valsalva retinopathy. If it is larger than 3-disc diameters and persists for more than 3 weeks; it may be drained into vitreous with an Nd-YAG laser. Purtscher retinopathy is an occlusive microvasculopathy resulting from severe head trauma or compression injuries of the thorax. Intraretinal hemorrhages, geometric white areas (Purtscher flecken), and cotton wool spots are typical features. Usually fades within 1-2 months. Medicolegal aspects as well as ocular and systemic associations are also important in closed globe injuries and should not be neglected.

Optical coherence tomography findings after surgery for sub-inner limiting membrane hemorrhage due to ruptured retinal arterial macroaneurysm

Ruptured retinal arterial macroaneurysm (RAM) can cause sub-inner limiting membrane (ILM) hemorrhage, leading to acute vision loss in the elderly. Vitrectomy has been established as an effective treatment to remove hemorrhage and facilitate visual recovery. Although optical coherence tomography (OCT) is useful for the diagnosis of sub-ILM hemorrhage before surgery, little is known about the postoperative OCT findings. Here, we retrospectively investigated the records of nine eyes of nine patients who underwent surgery for sub-ILM hemorrhage due to RAM rupture. On postoperative OCT, hyperreflectivity throughout the full thickness of the central fovea was observed in eight eyes (88.9%), and disruption of the ellipsoid/interdigitation zone (EZ/IZ) was observed in seven out of eight eyes (87.5%). The widths of the hyperreflectivity and EZ disruption gradually decreased. Visual recovery was least favorable in two eyes, in which the EZ line continuation did not recover until the final follow-up. The OCT findings corresponded to the hemorrhagic staining identified on fundus photographs in at least four eyes; as per the fundus photographs the findings persisted even after the hemorrhage was absorbed. In contrast, the OCT findings resembled the appearance before the development of a full-thickness macular hole, suggesting fragility caused by the RAM rupture.

Efficiency and Complication of 577-nm Laser Membranotomy for the Treatment of Retinal Sub-Inner Limiting Membrane Hemorrhage.

We investigated the clinical efficiency and complications of treatment of retinal sub-inner limiting membrane (sub-ILM) hemorrhage by 577-nm semiconductive laser membranotomy. The clinical features, ocular fundus photography, and SD-OCT image of patients who received 577-nm laser membranotomy for sub-ILM hemorrhage were assessed from January 2017 to April 2022 in this retrospective case-series study. A total of 19 patients (19 eyes) were treated for sub-ILM hemorrhage of the macula, in which eight were women and 11 were men. The age was 15-83 years (with an average age of 49.05 ± 19.41 years old). The right eye was affected in 12 patients, the left eye in seven patients. The follow-up period after laser treatment was from 0.5 to 9 months (with an average follow-up time of 3.25 ± 2.45 months). Treatment was not successful in one patient, and 577-nm laser membranotomy was successful in 18 patients (equaling a success rate of 94.74%). The best corrected visual acuity (BCVA) before laser treatment was from figure count to 40/200, and the BCVA after laser treatment was from 20/2000 to 20/20. Complications after laser treatment comprised macular hole (one patient), macular epi-membrane (one patient), vitreous hemorrhage without absorption (two patients), and sub-ILM cavity (12 patients). The 577-nm laser is effective in treating sub-ILM hemorrhage and has a high success rate. Posttreatment complications should be monitored, and vitrectomy was needed with long-lasting vitreous hemorrhage and macular hole.

Timely Vitrectomy and Inner Limiting Membrane Peeling Is Effective and Safe for Terson Syndrome With Vitreous Hemorrhage and Sub-Inner Limiting Membrane Hemorrhage.

Timely Vitrectomy and Inner Limiting Membrane Peeling Is Effective and Safe for Terson Syndrome With Vitreous Hemorrhage and Sub-Inner Limiting Membrane Hemorrhage.

Кровоизлияние под внутреннюю пограничную мембрану, активная хирургическая тактика

Purpose. Conduct a retrospective analysis of the results of treatment of sub-inner limiting membrane haemorrhage. Material and methods. A retrospective analysis of 11 cases of treatment of sub-inner limiting membrane haemorrhage was carried out. The initial visual acuity, the presence or absence of complications were assessed. Results. Initial visual acuity (BCVA) 0,15 ± 0,24. In two cases, we observed the patients, the hemorrhage resolved on its own, visual acuity improved. Vitrectomy with ILM peeling was performed in 9 cases. In all cases, an improvement in vision was obtained, BCVA after 1 month was 0,75 ± 0,11. A complication in the form of a macular hole was obtained in one case, the patient was re-operated, as a result, the macular hole was closed, visual acuity rose to 0.3 from the initial 0.01. Conclusion. Vitrectomy with ILM peeling improved vision in all operated patients with sub-inner limiting membrane haemorrhage. Keywords: sub-inner limiting membrane haemorrhage, vitrectomy, Valsalva retinopathy.

Follow-up of a traumatic sub-internal limiting membrane hemorrhage after exposure to a recreational laser

Follow-up of a traumatic sub-internal limiting membrane hemorrhage after exposure to a recreational laser

TREATMENT OPTIONS FOR PREMACULAR AND SUB-INTERNAL LIMITING MEMBRANE HEMORRHAGE.

Premacular hemorrhage (PH) and sub-internal limiting membrane hemorrhage (sub-ILM-H) are among the causes of sudden deterioration of central visual acuity. Anatomical and functional outcomes of different therapeutic options were evaluated retrospectively. The study included three eyes of three patients (2 females and 1 male). Location of the hemorrhage was determined by spectral domain optical coherence tomography. Subhyaloid premacular location of the hemorrhage was proven in one eye of each woman and sub-ILM location of the hemorrhage in one eye of the male. The baseline best corrected visual acuity (BCVA) was 0.63 in the eyes of the females and 0.16 in the eye of the male. Conservative treatment option was chosen in case of juxtafoveolar PH in the eye of the female patient on anticoagulant warfarin therapy. The female patient with PH secondary to proliferative diabetic retinopathy (PDR) underwent Nd: YAG laser hyaloidotomy. The male patient with unexplained cause of the sub- ILM-H underwent 25-Gauge vitrectomy with ILM peeling and subsequent ultrastructural morphometric and histopathological examination of the ILM. Both BCVA and retinal finding improvement were achieved in all patients. Final BCVA was 0.8 in the eye of the female patient with PDR and 1.0 in rest of the eyes of the other patients. No complications were recorded at follow-up visits. Histopathological and morphometric examination demonstrated variable ILM thickness (2.70 ±1.58 μm) and proved presence of fibroblasts and macrophages with hemosiderin deposits on the retinal side of ILM. The choice of the treatment option of PH and sub-ILM-H depends on input parameters such as the initial BCVA, the extent and the location of the hemorrhage, as well as the overall health of the patient. Nd: YAG laser hyaloidotomy is an effective method for rapid recovery of visual functions. Surgical ILM peeling and aspiration of the underlying hemorrhage result in the removal of breakdown products of hemoglobin and minimization of the risk of secondary epiretinal membranes development.

Sub internal limiting membrane hemorrhage followed by bilateral optic disc hemorrhage in Kikuchi-Fujimoto disease: a case report

BackgroundKikuchi-Fujimoto disease (KFD) is a necrotizing lymphadenitis, and presents fever of unknown origin and cervical lymphadenopathy. Ocular complications are unusual in KFD. Here we report a case of sub internal limiting membrane (ILM) hemorrhage followed by bilateral optic disc hemorrhage in KFD.Case presentationA 16-year-old Japanese man perceived a sudden decrease of right vision 3 days after onset of fever with unknown origin and left cervical lymphadenopathy. At presentation, visual acuity (VA) of right eye was 0.05 in decimal chart (1.30: converted to logarithm of minimum angle of resolution: logMAR). Fundus photograph showed extensive sub-ILM hemorrhage in right eye, and optic disc hemorrhages in both eyes. Fluorescein angiography presented hypo- and hyperfluorescences in optic disc of right eye, and hyperfluorescence in the disc of left eye. To make a definitive diagnosis, cervical lymph node biopsy was performed, and KFD was diagnosed pathologically. Thereafter, fever, headache and the cervical lymphadenopathy disappeared spontaneously. The sub-ILM hemorrhage was drained into the vitreous cavity by neodymium:yttrium-aluminum-garnet laser (Nd: YAG) hyaloidotomy. VA recovered to 1.5 (− 0.18: logMAR VA) in right eye.ConclusionSub-ILM hemorrhage and optic disc hemorrhage are a KFD-related ocular complication.

Fundus and Optical Coherence Tomography Findings of Sub-internal Limiting Membrane Hemorrhage Following Retinal Arterial Macroaneurysm

Fundus and Optical Coherence Tomography Findings of Sub-internal Limiting Membrane Hemorrhage Following Retinal Arterial Macroaneurysm

Sub-inner limiting membrane hemorrhage following a laser show

Sub-inner limiting membrane hemorrhage following a laser show

Intraoperative optical coherence tomography (I-OCT)-guided identification of resolved sub-internal limiting membrane hemorrhage in leukemic retinopathy

Intraoperative optical coherence tomography (I-OCT)-guided identification of resolved sub-internal limiting membrane hemorrhage in leukemic retinopathy

Visual and Anatomic Outcomes of Premacular Hemorrhage in Non-Accidental Trauma Infants Managed With Observation or Vitrectomy.

The management of premacular hemorrhage secondary to non-accidental trauma (NAT) is unclear. The authors describe the outcomes of NAT infants referred for surgical evaluation of premacular hemorrhage. Retrospective institutional review board-approved case series between 2000 and 2019 of vision-threatening premacular hemorrhage (sub-hyaloid or sub-internal limiting membrane hemorrhage without vitreous hemorrhage) in NAT infants. Time to hemorrhage resolution, vision, and comorbidities were collected. Thirty-six patients (62 eyes) with mean age of 5.4 months (range: 2-10 months) were included. Nine eyes (14.5%) underwent vitrectomy. Median time to hemorrhage resolution by observation was 75 days (interquartile range [IQR]: 60-120 days), and time to vitrectomy was 54.5 days (IQR: 47.8-58.5 days). Eight eyes (12.9%) had amblyopia, which was not significantly different between groups. Despite hemorrhage clearance, a higher proportion of eyes in the vitrectomy group had pigmentary changes (P = .04) and strabismus (P = .002) at follow-up. Most cases of NAT-related premacular hemorrhage resolve within 3 months without surgical intervention. Comorbidities may limit visual prognosis. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:715-722.].

Valsalva retinopathy induced by handstand: a case report

BackgroundValsalva retinopathy is known to occur as a sudden preretinal or sub-internal limiting membrane hemorrhage induced by a rapid rise in venous pressure following increased intrathoracic or intraabdominal pressure. Here we report a case of Valsalva retinopathy that was probably induced by straining that occurred due to following a handstand.Case presentationA 15-year-old boy became aware of decreased visual acuity in his left eye immediately after doing a handstand for approximately 10 s during physical education class, and subsequently visited a local clinic on the same day. Upon examination, a vitreous hemorrhage (VH) in the posterior pole of the fundus was found in his left eye, and he was subsequently referred to our department 7 days later. Upon examination, the VH around the optic nerve head of the left eye appeared to be resolved, and an oval-shaped sub-internal limiting membrane (sub-ILM) hemorrhage was found in the superonasal side of the optic nerve head. No abnormalities were observed in the macular area. Four months later, the sub-ILM hemorrhage was found to have spontaneously resolved. Subsequent fluorescein angiography examinations revealed no abnormal findings at the lesion site.ConclusionsIn this patient, we hypothesize that the Valsalva retinopathy was induced by straining that occurred due to a handstand, and that the resultant sub-ILM hemorrhage progressed to VH.

Sub–Internal Limiting Membrane Hemorrhage after Stent-Assisted Coil Embolization

Sub–Internal Limiting Membrane Hemorrhage after Stent-Assisted Coil Embolization