Premacular Hemorrhage Research Articles

AYURVEDIC MANAGEMENT OF PRE-MACULAR HAEMORRHAGE: A CASE STUDY

Pre-macular haemorrhage (PMH) is a condition characterized by bleeding between hyaloid and retina leading to visual impairment. Ayurveda offers extensive treatment protocols for managing such posterior segmental disorders. This case study presents the successful Ayurvedic management of PMH in a 54-year-old female patient who is a known hypertensive. The patient presented with a sudden onset of blurred vision in the right eye and black patches in the vision. After a thorough Ayurvedic assessment, a treatment plan including Netra kriyakalpas and panchakarma procedures was adopted along with oral medications. For one month, the patient experienced significant improvement in visual acuity, and the resolution of the haemorrhage was confirmed by ophthalmological examination and imaging studies. This case highlights the potential of Ayurveda as an effective approach to managing pre-macular haemorrhage.

Neonatal Macular Hemorrhage in a Term Healthy Infant: 18-Year Follow-up.

Unobstructed binocular vision is required during the critical period of vision development to obtain optimal visual acuity in each eye and binocular stereopsis. In this article, we report 18-year follow-up of a full-term, otherwise healthy infant noted to have dense premacular hemorrhage occluding the visual axis in the left eye on retinal imaging performed 48 hours after birth. Serial examinations by the retina service were performed weekly for 10 weeks as the hemorrhage resolved spontaneously. Shortly thereafter, visual acuity revealed fixation was present, but the mother noted intermittent left eye esodeviation. At 90 days of life, the infant was seen by pediatric ophthalmology and started on 1 to 2 hours patching of the right eye daily for the esotropia, which was maintained through 24 months. At 18 years of age, the patient had orthophoria alignment, no spectacle correction, vision of 20/20 in the right eye and 20/25 in the left eye, and normal binocularity and stereopsis. Intermittent esodeviation on the left eye was observed when the patient was fatigued. Early identification of a visual axis occlusion led to prompt referral for the esotropia and initiation of patching therapy. This patient ultimately achieved a very favorable visual functional outcome that may not have been possible without early detection and management. This case report describes the longest-term published follow-up of a neonatal macular hemorrhage. [Ophthalmic Surg Lasers Imaging Retina 2024;55:354-357.].

Evaluation of a new Q-switched Nd:YAG laser on premacular hemorrhage

BackgroundPremacular hemorrhage is among the causes of sudden deterioration of visual acuity. This study aimed to investigate the therapeutic outcomes of a new Q-switched Nd:YAG laser on premacular hemorrhage.MethodsRetrospective, case series study of 16 eyes from 16 patients diagnosed with premacular hemorrhage, including 3 cases of Valsalva retinopathy, 8 cases of retinal macroaneurysm, 3 cases of diabetic retinopathy, 1 case of trauma-related hemorrhage and 1 case with leukemia. A 1064nm Q-switched Nd:YAG laser was performed to puncture the posterior hyaloid and inner limiting membrane to drain the hemorrhage.ResultsThe success rate of 16 patients with premacular hemorrhage drainage was 100% in this study. Improved visual acuity was observed in each patient.ConclusionsIn this case series of 16 patients, the new Q-switched Nd:YAG laser was successful in draining premacular hemorrhage with no serious complications.

Spontaneous resolution of parafoveal macular hole post YAG hyaloidotomy in a case of Valsalva retinopathy.

To report a rare case of spontaneous resolution of parafoveal macular hole post YAG hyaloidotomy in case of Valsalva retinopathy. Case Report. A 29-year-old female presenting with sudden diminution of vision in her left eye (LE) for two months following a bout of vomiting was diagnosed with pre-macular haemorrhage. Patient was planned for YAG hyaloidotomy on the same day followed by propped up positioning. On follow up haemorrhage was seen to be cleared around macula with corresponding improvement of visual acuity. Patient was found to have developed a parafoveal hole post procedure which spontaneously healed without any intervention. Visual acuity was subsequently improved with resolution of macular hole as seen on fundus imaging and Optical coherence tomography (OCT). Pre-macular haemorrhage is quite common phenomenon in Valsalva retinopathy cases and YAG hyaloidotomy is an established surgical modality for management of the same in literature with good clinical outcomes. However, formation of macular hole is not very common but described in literature post procedure. It is a rare phenomenon to have spontaneous resolution of macular hole. Hence, observation can be an option for managing such cases.

Differentiation of premacular hemorrhages with niveau formation.

Differentiation of premacular hemorrhages with niveau formation.

Multilayered premacular haemorrhage associated with central retinal vein occlusion

AbstractPurpose: We aimed to report a rare case of multilayered premacular haemorrhage complicating central retinal.vein occlusion (CRVO) and to describe its management and follow‐up.Methods: An observational case report of a 38‐year‐old man with no medical history who presented with sudden loss of vision in his left eye (LE) 4 days ago. The patient underwent complete ophthalmologic examination, fluorescein angiography (FA) and swept‐source optical coherence tomography (SS‐OCT).Results: Ophthalmologic examination of the right eye (RE) was unremarkable with a best‐corrected visual acuity (BCVA) of 20/20. In the LE, BCVA was limited to light perception (LP), intraocular pressure was 12 mmHg and anterior segment showed no abnormalities. Ophthalmoscopy showed dilated veins, multiple flame haemorrhages and a large dome‐shaped premacular haemorrhage with a double‐ring sign. SS‐OCT revealed a dome shaped clotted haemorrhage surrounded by hyperreflective dots under the internal limiting membrane (ILM) corresponding to a multilayered sub‐ILM haemorrhage. On FA, we noticed a delay in venous filling time and no areas of capillary‐non perfusion. Systemic work‐up with glaucoma screening were unremarkable. Nd:YAG laser hyaloidotomy and membranotomy of the ILM were performed. At one‐week follow‐up, there was evidence of the sub‐ILM and subhyaloid blood draining into the vitreous cavity. At 3 weeks following the laser treatment, persistence of clotted blood was noted. Pars plana vitrectomy with ILM peeling were performed. Two months post‐operatively, BCVA improved from LP to 20/25 with complete resolution of the haemorrhages on fundoscopy and SS‐OCT.Conclusions: Premacular haemorrhage associated with CRVO is a rare condition. SS‐OCT allows accurate diagnosis and non‐invasive follow‐up. Nd: YAG laser hyaloidotomy should be considered as the first line treatment. But if failed, vitrectomy with ILM peeling should not be delayed in order to avoid toxic damages to the retina.

A brief review of Valsalva retinopathy

Background: Valsalva retinopathy is a specific type of retinopathy that appears following an acute rise in intrathoracic or intra-abdominal pressure. This review focuses on current literature and future directions for the diagnosis and management of Valsalva retinopathy.
 Methods: In this brief review, the literature was searched to provide an extensive general and updated description of Valsalva retinopathy, focusing on its management and prognosis. Selected articles are summarized to present the etiology, general pathology, pathophysiology, symptoms, signs, diagnosis, differential diagnosis, treatment, and prognosis of Valsalva retinopathy.
 Results: The main symptom of Valsalva retinopathy is loss of visual acuity following exertion. This is caused by the rupture of small superficial vessels in the macula and perimacular areas, leading to extravasation of blood. No link between age, sex, or race has been found, although fundus vessel abnormalities pose some predisposition to the disease. During fundoscopy, Valsalva retinopathy appears most frequently as well-defined preretinal hemorrhages confined to the sub-internal limiting membrane (ILM) or subhyaloid space. If ILM rupture occurs, hyaloid hemorrhage can appear. Diagnosis is based on the patient’s medical history and a standard examination. Usually, only observation of the patient is required, with the hemorrhage resolving within weeks to months. In cases of large premacular hemorrhage or large sub-ILM/subhyaloid hemorrhage, vitrectomy or Nd:YAG krypton laser membranotomy can be performed.
 Conclusions: Of all the aspects of Valsalva retinopathy that might trouble the physician, the most challenging features are differential diagnosis and the choice of optimal treatment. Therapeutic strategies for Valsalva retinopathy can be either conservative or based on Nd:YAG laser membranotomy and/or vitrectomy. All methods seem to have good outcomes. However, physicians should not be afraid of advancing beyond conservative therapy, especially in the event of persistent premacular hemorrhage, which could lead to permanent retinal damage if valuable time is lost, even after vitrectomy.

Nd:YAG laser vitreolysis in the treatment of premacular subhyaloid hemorrhage

Nd:YAG laser vitreolysis in the treatment of premacular subhyaloid hemorrhage

Inverse drainage Nd:YAG membranotomy for pre-macular hemorrhage.

To report the outcomes of the "inverse drainage Nd:YAG laser membranotomy" technique for the management of pre-macular hemorrhage (PMH), which has its inferior margin near the fovea. This retrospective study included eyes with PMH, with its inferior margin located within 0.5 disc-diameter (DD) of the fovea. Laser membranotomy was performed near the superior margin of PMH followed by intravitreal injection of 0.3 mL undiluted sulphur hexafluoride (SF6) gas. The patients were advised to maintain a prone position for three days. Twenty patients (20 eyes) with a mean age of 46.1 ± 18.6 years were included in the study. The mean duration of symptoms was 6.9 ± 7.0 days. The mean size of PMH was 4.1 ± 1.2DD. The causes of PMH were Valsalva retinopathy (n = 11) and retinal artery macroaneurysm (RAM, n = 9). The mean maximum height of the blood collection, measured by optical coherence tomography (OCT), within 1 disc-diameter from the inferior and superior borders of the PMH was 738.9 ± 232.9μm and 1240.6 ± 338.1μm respectively (p = 0.001). The mean best-corrected visual acuity (BCVA) improved from logMAR 1.32 ± 0.44 (Snellen equivalent, 20/418) to logMAR 0.11 ± 0.20 (Snellen equivalent, 20/26) (p = 0.001). Vitrectomy was not required in any case. Persistent pre-macular cavity, macular hole, epiretinal membrane (ERM), intra-ocular pressure spike, or rhegmatogenous retinal detachment (RRD) was not noted in any patient. This technique can be safely used to treat eyes with PMH having its inferior margin near the fovea.

VALSALVA MACULOPATHY FOLLOWING STRENUOUS ACTIVITY: A CASE REPORT

Valsava maculopathy is one of many causes of premacular hemorrhage. This case report highlights the interest of multimodal imaging in the diagnosis of retinal emergencies which can engage the visual prognosis, especially in a young patient as in our case of Valsalva Maculopathy.A 32 years old male arrived at the ophthalmology emergency for a sudden painless loss of central vision in his left eye after doing some heavy dumbbell exercises without any context of traumatism. After the eye examination, he was been diagnosed with Valsalva maculopathy. The bleeding spontaneously resorbed. Follow-up after 12 weeks was uneventful.

Valsalva retinopathy in Nigerians: A case series

Valsalva retinopathy is considered rare. Patients present with sudden visual loss due to premacular hemorrhage. Treatment depends on the presentation. Three patients presented to us between 2013 and 2022 with sudden visual loss caused by Valsalva retinopathy. Case 1 was a 26-year-old female primigravida with right premacular hemorrhage after severe vomiting which was treated with pneumatic displacement with air. Case 2 was a 23-year-old male with left premacular hemorrhage. He had no memory of a Valsalva maneuver. He had vitrectomy for premacular dehemoglobinized non-resolving hemorrhage. Case 3 was a 27-year-old pregnant female with left premacular hemorrhage after vomiting. She was managed conservatively. Large, dense, or non-resolving hemorrhages require treatment while small hemorrhages may spontaneously resolve. The patients had different treatment strategies with good outcomes

Exercise-induced Valsalva retinopathy: A case report and literature review

Introduction. Valsalva retinopathy is an uncommon disorder that usually presents with acute onset of unilateral, or less frequently, bilateral visual impairment varying from subtle scotoma to total vision loss. It occurs as a result of Valsalva?s maneuver. In the vast majority of cases, hemorrhage is preretinal although subretinal, intraretinal and vitreous hemorrhage can be found. Valsalva retinopathy often develops due to numerous triggering activities such as vomiting, coughing, heavy weight lifting, intense aerobic exercise, labor, and general anesthesia. Management options are either clinical observation or invasive techniques. We report a case of premacular hemorrhage due to Valsalva retinopathy induced by gym training. Case outline. A 34-year-old woman was referred to the Eye Clinic, University Clinical Center of Serbia, complaining of sudden and painless unilateral decrease in vision occurred during intense physical activity. Best corrected visual acuity was measured as counting fingers at five meters distance. Dilated fundoscopy demonstrated a large, well demarcated premacular subhyaloid hemorrhage with visible rupture of the retinal vein branch. The patient was treated conservatively. Three months after the onset of symptoms, hemorrhage absorbed and best corrected visual acuity was 20/20. Conclusion. Valsalva retinopathy, although a rare condition, should not be omitted as a differential diagnosis of retinal and vitreous hemorrhages. Standard, observational treatment is generally sufficient for complete vision recovery; however, literature suggests that an individualized approach to each patient is required.

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.

Weather as a possible risk factor for massive ocular decompression retinopathy: A case report.

Numerous studies described a link between weather phenomena and an increased incidence of cardiovascular and cerebrovascular events. We report a case of ocular decompression retinopathy with massive premacular haemorrhage secondary to acute intraocular pressure reduction in a patient with acute primary angle closure. At the time of admission, a change in weather conditions occurred with high temperatures and a strong Foehn wind known locally as halny. A healthy 56-year-old man with acute primary angle closure who developed severe ocular decompression retinopathy with large prefoveal subhyaloid haemorrhage after pharmacological treatment was admitted to the hospital. The patient was elected for surgery and underwent vitrectomy with improvement of visual acuity to the baseline vision. This report suggests that, in addition to an abrupt reduction in intraocular pressure as a causative factor, massive ocular decompression retinopathy may be significantly influenced also by environmental factors such as halny.

Retinal racemose hemangioma and macroaneurysm with multilayered hemorrhage

A 42-year-old female presented with sudden diminution of vision in the right eye (RE) for 1 day. The vision was counting fingers with Relative afferent pupillary defect (RAPD) (RE) and 20/20 (LE). Fundus revealed dilated tortuous arteries and veins in all quadrants with premacular and submacular hemorrhage. Fundus fluorescein angiography (FFA) showed nonleaking vascular loops with hypofluorescence at the macula. Optical coherence tomography (OCT) revealed localized posterior hyaloid detachment with hemorrhage. We report this unilateral case of retinal racemose hemangioma with multilayered hemorrhage managed with pneumatic displacement and revealed retinal artery macroaneurysm in the background. On follow-up there was development of localized vitreomacular traction. It was treated with Yttrium Aluminium Garnet (YAG) hyaloidotomy, which improved vision to 20/80.

Hemorrhagic Eye Involvement in Acute Myeloid Leukemia

Purpose: Through an observation, we focus on the ocular hemorrhagic manifestations during AML and the role of the ophthalmologist in the management of this condition. Methods: We report the case of a 14-year-old boy whose hemorrhagic ocular involvement was indicative of an AML. Results: This patient with no known history was sent for an ophthalmology consultation for a sudden decline in bilateral visual acuity associated with a bilateral periorbital ecchymosis. The interrogation found an effort of vomiting preceding the ocular symptoms and a notion of purpuric spots on the lower limbs 3 months ago. Distance visual acuity has been rated at 1/10 on the right and counts the fingers on the left. Examination of the anterior segment mainly revealed periorbital ecchymosis and diffuse bilateral subconjunctival hemorrhage. Fundus analysis revealed bilateral diffuse retinal hemorrhage, premacular retro-hyaloid hemorrhage on the right and macular hemorrhage on the left. An emergency blood count showed anemia with hemoglobin (Hb) level of 5.5g/dL and thrombocytopenia at 15,000/µL. Hyperleukocytosis at 126420/µL with monocytes at 84700/µL and neutrophils at 3312/µL. The patient was immediately referred to a hematologist and an oncologist. The investigations and the myelogram made it possible to make the diagnosis of acute myeloid leukemia. Conclusions: Although the ophthalmologist plays a secondary role in the treatment of leukemia, he must be able to recognize the eye symptoms indicative of systemic disease and collaborate with hematologists and oncologists in the follow-up and management of patients.

A case of air pollution-induced Valsalva retinopathy

This is a case of Valsalva retinopathy during the season of annual transboundary haze pollution in Sarawak. A 22-year-old man with no known medical illness developed sudden onset of painless visual acuity loss preceded by persistent cough. Left eye fundus showed dense preretinal haemorrhage covering optic disc extendinginferiorly with breakthrough vitreous haemorrhage. The patient underwent pars plana vitrectomy, endolaser, and fluid gas exchange in view of persistent dense vitreous haemorrhage after a month of conservative management. In conclusion, pars plana vitrectomy can be considered as a safe and effective treatment option for patients with Valsalva retinopathy developing extensive premacular haemorrhage.

Clinical and spectral-domain optical coherence tomography findings in Valsalva retinopathy

Valsalva retinopathy is a prominent cause of premacular hemorrhage in young patients. We report the case of a young male patient with premacular hemorrhage due to Valsalva retinopathy who underwent Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) laser evacuation of the blood. Within 5 minutes, there was a significant clearance of the blood from the macular area. A week later we could demonstrate a vascular sign on fluorescein angiography. It is known that the source of blood in Valsalva retinopathy is the rupture of perifoveal capillaries. Based on the findings on fluorescein angiography we could postulate that the bleeding in our case could have been due to the rupture of a larger retinal venule.

Valsalva retinopathy in a teenager treated with Nd:YAG laser posterior hyaloidotomy.

A 14-year-old otherwise healthy male patient presented with acute left loss of vision for 3 hours following weightlifting. Examination showed dense pre-macular sub-hyaloid hemorrhage (A). The patient and his parents did not like to wait for gradual spontaneous resolution of the hemorrhage. Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior hyaloidotomy was performed with quick drainage of blood into the vitreous cavity (B,C,D). He maintained stable vision and retinal exam over 20 months of follow-up. Valsalva retinopathy can affect pediatric as well as adult age groups. Nd:YAG laser posterior hyaloidotomy is minimally invasive and safe procedure that provides rapid visual rehabilitation in cooperative patients.

Лазерное лечение осложненной ретинальной артериальной макроаневризмы

The article presents different approaches to laser treatment of retinal arterial macroaneurysm, complicated by exudation and hemorrhage in the macula. The treatment included barrier and direct coagulation of retinal arterial macroaneurysm with 532 and 577 nm lasers, laser hyaloidotomy of premacular hemorrhage using a 1064 nm. YAG laser. Dynamic observation was performed using fluorescence angiography and OCT angiography. Positive and stable functional results were achieved. A conclusion has been drawn on the effectiveness of laser coagulation in combination with hyaloidotomy in the treatment of complicated retinal arterial macroaneurysm.