Premacular Hemorrhage Research Articles

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.].

Premacular Hemorrhage after Stent Placement for Paraophthalmic Aneurysms

Premacular Hemorrhage after Stent Placement for Paraophthalmic Aneurysms

Bilateral and multiple sub-internal limiting membrane hemorrhages in a familial retinal arteriolar tortuosity patient by Valsalva-like mechanism: an observational case report

BackgroundBilateral and multiple Valsalva-related sub-internal limiting membrane (ILM) hemorrhages in a familial retinal arteriolar tortuosity (FRAT) patient is rare, and we treated this patient by both observation and Neodymium yttrium aluminum garnet (Nd: YAG) laser membranotomy methods.Case presentationA 13-year-old female student presented with sudden visual loss and central scotoma in both eyes after running 800 m at the school gym. The examination revealed six sub-ILM hemorrhages with the biggest hemorrhage measuring approximately 1.5-disc diameters (DD) in the right eye and two sub-ILM hemorrhages with the biggest one measuring 5.5 DD in the left eye. The patient was diagnosed as having Valsalva retinopathy associated with FRAT. Nd: YAG laser membranotomy was performed at the biggest hemorrhages and the rest hemorrhages were treated with observation in both eyes. The visual acuity recovered to 20/16 in the right eye and 20/20 in the left eye. Epiretinal membrane (ERM) formation was observed in the left eye.ConclusionsNd: YAG laser could be considered for treating premacular hemorrhage in FRAT patient especially when a quick vision recovery was needed. This is the first reported case of a FRAT patient suffering from bilateral and multiple Valsalva-related sub-ILM hemorrhages which were treated by both observation and Nd: YAG laser treatment.

Acute vision loss in a patient with chronic esophageal stenosis

Abstract:
 Purpose: To describe a unique cause of Valsalva Retinopathy (VR) with an alternative surgical approach to chronic non-clearing pre-foveal hemorrhage.
 Method: Case presentation.
 Results: A 45-year-old African American female presented with acute vision loss from 20/20 to count fingers (CF) in her right eye. Ophthalmoscopy and ocular coherence tomography (OCT) showed old yellow-red pre-retinal opacityscuring the fovea. After 1 month of conservative management with no improvement, Pars Plana Vitrectomy (PPV) with posterior hyaloid membrane removal without ILM peeling was performed with the patient’s best-corrected visual acuity (BCVA) dramatically improved to 20/25.
 Discussion: We raise the question regarding the role of ILM peeling in treating premacular hemorrhage. Even without ILM peeling, our patient’s hemorrhage resolved after the procedure. This suggests that PPV combined with posterior hyaloid removal is a safer and effective alternative to surgical treatment in patients with certain clinical conditions. In addition, we provide clear evidence to support the location of the hemorrhage in VR as both sub-hyaloid and sub-ILM.

Nd:YAG Laser Hyaloidotomy for Premacular Hemorrhage in Diabetic Eyes

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Photoreceptor damage following long-standing premacular hemorrhage in Terson syndrome.

Photoreceptor damage following long-standing premacular hemorrhage in Terson syndrome.

Preretinal hemorrhages after accidental exposure to a laser pointer: Two case reports

We report here cases of subhyaloid premacular haemorrhage and vitreous haemorrhage in two young patients after accidental exposure to a laser pointer.

Anti-Myelin Oligodendrocyte Glycoprotein Optic Neuritis Presenting with Dense Premacular Hemorrhage

Anti-Myelin Oligodendrocyte Glycoprotein Optic Neuritis Presenting with Dense Premacular Hemorrhage

Recurrent pre-retinal haemorrhages associated with coagulation factor VII deficiency

Abstract The case concerns a 20 year-old woman with a sudden visual loss in her left eye. In the fundus examination, a focal pre-retinal haemorrhage was observed in the superior temporal vascular branch with accompanying vitreous haemorrhage. There was a favorable spontaneous outcome. Eighteen months later, she presented with a new visual loss in the same eye, showing a sub-hyaloid pre-macular haemorrhage that was satisfactorily drained by hyaloidotomy using a Nd-YAG laser. The patient had also presented with an upper digestive tract haemorrhage and menorrhagia. A haemostasis study was performed that showed a coagulation factor VII deficiency. This is a very uncommon disorder that has not been previously described in association with the appearance of pre-retinal haemorrhages.

ИАГ-лазерная гиалоидотомия в лечении премакулярных кровоизлияний

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Hemorragias prerretinianas de repetición asociadas a déficit del factor VII de la coagulación

The case concerns a 20 year-old woman with a sudden visual loss in her left eye. In the fundus examination, a focal pre-retinal haemorrhage was observed in the superior temporal vascular branch with accompanying vitreous haemorrhage. There was a favourable spontaneous outcome. Eighteen months later, she presented with a new visual loss in the same eye, showing a sub-hyaloid pre-macular haemorrhage that was satisfactorily drained by hyaloidotomy using a Nd-YAG laser. The patient had also presented with an upper digestive tract haemorrhage and menorrhagia. A haemostasis study was performed that showed a coagulation factor VII deficiency. This is a very uncommon disorder that has not been previously described in association with the appearance of pre-retinal haemorrhages.

Accidental Laser-Induced Macular Holes: A Case Series

Purpose: The purpose of this article is to report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser. Methods: The design included a consecutive case series of 4 patients. Evaluation included a full ophthalmic examination and macular spectral-domain optical coherence tomography. Main outcome measures included an analysis of the types of maculopathy and vitreoretinal pathological features. Results: All patients were young men. The most common setting for injury was accidental at play. The types of maculopathies encountered were a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub–internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Snellen best-corrected visual acuity (BCVA) at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. All 4 FTMHs were closed successfully after pars plana vitrectomy. Final mean BCVA in all cases was 20/35. Conclusions: Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous, and public awareness should be encouraged.

Visual Outcome of Pars Plana Vitrectomy for Treatment of Premacular Hemorrhage

Background: premacular hemorrhage can lead to painless loss of central vision. Several modalities of treatment have been described in previous reports. Purpose: to evaluate the visual outcome after pars plan vitrectomy (PPV) for treatment of premacular hemorrhage of different etiology. Patients and methods: A series of retrospective study 17 eyes of 17 patients presented with premacular hemorrhage due to different pathologies. Complete ophthalmic evaluation was done including visual acuity (VA), intraocular pressure (IOP), anterior segment examination, slit lamp biomicroscopy, fundus photography± fluorescein angiography (FA), and ocular ultrasound ± biometry. PPV was performed using 23gauge system with proper tamponade ± Phaco with PCIOL.No intraoperative lens touch or iatrogenic retinal tear has been recorded. Results: BCVA was improved from CF 50 cm in2 cases, hand movement (HM) in 15 cases to 0.1 (Log MAR) in 2 eyes (11.76%), 0.3 in one eye (5.88%), 0.4 in 5 eyes (29.41%), 0.6 in 3 eyes (17.64%), 1.00 in 3 eyes (17.64%), (3/60) in 2 eyes (11.67%), CF (1/60) in one eye (5.88%). No serious complications weredetected. Conclusion: PPV is a beneficial surgical treatment for premacular hemorrhage of different pathologies ensuring rapid visual recovery. The visual outcome is an encouraging and the complications are comparable to other studies.

Visual Outcome of Pars Plana Vitrectomy for Treatment of Premacular Hemorrhage

Visual Outcome of Pars Plana Vitrectomy for Treatment of Premacular Hemorrhage

Multimodal imaging of pre-macular subhyaloid hemorrhage managed with Nd:YAG laser hyaloidotomy

Multimodal imaging of pre-macular subhyaloid hemorrhage managed with Nd:YAG laser hyaloidotomy

Nd:YAG laser therapy for non-resolving premacular subhyaloid hemorrhage in Saudi patients

PurposeTo report anatomical and visual outcomes of Nd:YAG laser posterior hyaloidotomy (NYPH) in Saudi patients affected by Premacular subhyaloid haemorrhage (PMSHH). Methods8 eyes from 8 patients (7 males and one female) were treated with NYPH when no spontaneous resolution of PMSHH was noticed. The cause of PMSHH was proliferative diabetic retinopathy (PDR) in 3 cases, Central retinal vein occlusion (CRVO) in 2 cases, Valsalva retinopathy in 2 cases, and laser pointer injury in one case. The YAG laser was delivered using a Q switched mode and 3 mirrors contact lens. One attempt of laser delivery was enough in 6 cases and 2 cases needed 2 attempts. The laser power needed ranged between 2 and 4 mJ. ResultsAnatomical success was achieved in all cases. The mean LogMAR VA improved from 1.5 before treatment to 0.3 post-treatment. The difference is statistically significant (p = 0.012). No complications related to Nd:YAG laser therapy was reported in any of the study cases until the last follow up. ConclusionTo our knowledge, this is the first study to report the outcomes of NYPH for non-resolving PMSHH in Saudi cases. In this small cases series, the procedure seems to be safe, effective, simple, cheap, and non-invasive treatment modality for this disorder that is conducted in the outpatient setting. We think it should be considered as a first option for cases of SHH covering the fovea due to various aetiologies.

Decompression retinopathy following nonpenetrating deep sclerectomy for primary congenital glaucoma

BackgroundTo describe a unique case of decompression retinopathy manifesting as pre-macular subhyaloid hemorrhage that occurs in a nine-day old child after undergoing a non-penetrating deep sclerectomy for primary congenital glaucoma.Case presentationWe report a single case of a 9-day-old boy who was referred to our department of ophthalmology for bilateral buphtalmia and corneal edema. He presented marked elevation of the intraocular pressure in both eyes (22 mmHg and 26 mmHg, in the right eye and left eye respectively) associated with significant optic nerve cupping.Non-penetrating deep sclerectomy was performed for each eye, with effective reduction of the intraocular pressure during the first week postoperatively (11 mmHg and 7 mmHg in the right eye and left eye respectively). The right eye presented an isolated subhyaloid hemorrhage located in the pre-macular area, persisting 3 weeks after the initial surgery and requiring pars-plana vitrectomy to clear the visual axis. This uncommon complication was identified as decompression retinopathy.The intraocular pressure remained controlled in the normal range three years after initial surgery in both eyes, with reversal of optic disc cupping.ConclusionsDecompression retinopathy is a potential complication after non-penetrating deep sclerectomy in primary congenital glaucoma, requiring prompt treatment strategy to prevent potential organic amblyopia.

Premacular sub-hyaloid hemorrhage in a patient with factor V leiden treated with YAG laser: A case report

Factor V leiden is an inherited disorder of blood clotting causing hypercoagulability and can often lead to retinal vein occlusions. This purpose of this case report is to present a spontaneous sub-hyaloid macular hemorrhage and impending retinal vein occlusion in a young woman found to be positive for factor V leiden. She was treated with YAG laser to open the posterior hyaloid face. This led to complete resolution of the hemorrhage with return of 6/6 visual acuity. We conclude that YAG laser treatment is an affective treatment in spontaneous sub-hyaloid macular hemorrhage in a positive factor V leiden patient. This is the first case study of spontaneous macular hemorrhage in a patient with such a mutation. This report also demonstrates the efficacy of YAG laser for premacular hemorrhage, which produces a rapid resolution and improvement in visual acuity.

Optical coherence tomography changes following vitrectomy for long standing premacular hemorrhage in Valsalva retinopathy.

Optical coherence tomography changes following vitrectomy for long standing premacular hemorrhage in Valsalva retinopathy.

Nd YAG LASER treatment for leukemic childhood blindness

Aim of the study: is to study the rule of laser therapy by the (Nd-YAG) laser in the treatment of premacular haemorrhage in leukemic childrenMethod:It is a prospective study was taken in department of ophthalmology in al hilla teaching hospital .eleven eyes of eight children 3 girls and 5 boys age between 7-14 years old and they have premacular haemorrhage due to leukaemia .family permission was taken after explaining to the family the surgical procedure .topical anesthesia by lidocaine and pupil dilatation by mydriacil and the Goldman 3 mirror and Nd –YAG laser was delivered the power was 5 mj and increased by 1 mj when the desired response not gained and the power should not exceed 11mj and the number of shoots should not exceed 10 per section and the pt was followed after 1 week then after 6 weeks then after 3 months.Results:Drainage of the premacular hemorrhage into the vitreous happened in 9 eyes of 11eyes after the end of the follow up period which is 3 months The mean force used was 6.5 mj.After 1 week the improvement in VA was between hand movement and 6/6 and the mean was 6/18After 6 weeks the improvement in VA was between hand movement and 6/6 and the mean was 6/9There is no big difference in improvement in VA after 3 months to that after 6 weeksOne pt who had lymphoblastic leukemia had clotted hemorrhage that could not be drained into the vitreousAnd another pt who had myeloid leukemia had re-hemorrhage as a result of deterioration in his illnessConclusion:From the result of this study we can see that the use of Nd-YAG laser in the treatment of leukemic pts with premacular hemorrhage is safe and effective in comparing with parsplana vitrectomy under GA specially when we use good selection of pt especially those with bilateral premacular hemorrhage and we can consider the Nd-YAG laser as a routine therapy for the leukemic children with premacular hemorrhage.