Premacular Hemorrhage Research Articles

Non-contact ultra-widefield retinal imaging of infants with suspected abusive head trauma

PurposeThe purpose of the study was to audit the use of non-contact ultra-widefield retinal imaging in infants with suspected abusive head trauma (AHT) using the Optos P200MA Scanning Laser Ophthalmoscope.Patients and methodsA retrospective, observational case series. Ten eyes of five consecutive infants (aged 1-15 months) with suspected (or in 1 case, known) AHT referred for an ophthalmological opinion were included. Each infant underwent non-contact ultra-widefield retinal imaging using the Optos P200MA scanning laser ophthalmoscope. Optos fundus fluorescein angiography (FFA) was performed in one infant with oral sedation. The other four infants did not require sedation. The main outcome measure was the acquisition of a single, definitive ultra-widefield retinal image in each eye. Safety was audited by determining adverse changes in heart rate and oxygen saturations that required cessation of imaging.ResultsThe Optos P200MA ultra-widefield scanning laser ophthalmoscope acquired good quality retinal images in all infants. Documentation of acute, widespread retinal haemorrhages contributed to a diagnosis of AHT in three infants. Chronic pre-macular haemorrhage and macular schisis were documented by FFA in a fourth infant. The absence of retinal haemorrhages was documented in a fifth infant contributing to the exclusion of a diagnosis of AHT. There were no adverse safety signals in any infant in this series.ConclusionThe Optos P200MA ultra-widefield scanning laser ophthalmoscope appears safe to use in infants with suspected AHT, providing high-quality retinal images in a single frame without ocular contact. Optos P200MA may be used as alternative to RetCam to document retinal haemorrhages in stable infants with suspected AHT.

Valsava Retinopathy: A review

The study was carried out to investigate the causes , presentation and management of premacular hemorrhage secondary to Valsava retinopathy in Port Harcourt. Case folders of patients who presented to the retina units of the University of Port Harco urt Teaching Hospital and a private hospital betwee n 2014 and 2016, were reviewed. Data collected includ es age, sex, presenting visual acuity, risk factors , and treatment modalities. Three eyes of two patient s were reviewed. One patient had bilateral premacular haemorrhage. Both patients had a very si gnificant improvement, with best corrected acuity of 6/6 within three weeks of conservative managemen t involving sleeping in standard Fowlers position. Valsava retinopathy though a rare condition can cau se a profound loss of vision. Spontaneous recovery with full visual function is common withou t intervention.

ИАГ-лазерная пункция при премакулярном кровоизлиянии на обоих глазах у пациента с острым миелобластным лейкозом

ИАГ-лазерная пункция при премакулярном кровоизлиянии на обоих глазах у пациента с острым миелобластным лейкозом

Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage.

BackgroundPremacular subhyaloid hemorrhage results in a sudden profound loss of vision. Among the modalities for its treatment, Nd:YAG laser hyaloidotomy is a non invasive method enabling rapid drainage of the obstructed macular area and improved vision within days. This study was aimed to evaluate the efficacy, visual outcome and complications following Nd:YAG laser hyaloidotomy for premacular subhyaloid hemorrhage.MethodsPatients with premacular subhyaloid hemorrhage of more than 3 disc diameters (DD) of various etiologies, attending Tilganga Institute of Ophthalmology, Nepal from August, 2014 to February, 2015, were included. A comprehensive ocular evaluation was conducted and fundus photographs were taken to measure the size of the subhyaloid hemorrhage. Optical coherence tomography (OCT) were performed before and after treatment and on subsequent follow up visits. Fundus fluorescence angiography was done whenever necessary. Q switched Nd:YAG laser was applied to create an opening in the posterior hyaloids membrane for draining subhyaloid hemorrhage. The main outcome measures were success rate in performing hyaloidotomy, drainage of subhyaloid blood into vitreous cavity and its resorption, improvement in visual acuity, need for further intervention and postoperative complications.ResultsThere were 21 eyes of 19 patients, 17(89.48 %) male and 2(10.52 %) female. In 3, premacular subhyaloid hemorrhage was bilateral. Mean age was 41.68 ± 17.08 years and a mean duration of symptoms 15.04 days. Mean pretreatment hemorrhage was 6.27DD. Nd:YAG laser hyaloidotomy was successful in 19 eyes(86.4 %). In 2 patients, one each with Eales’ disease and retinal vein occlusion the procedure was unsuccessful, necessitating pars plana vitrectomy, while in a case with proliferative diabetic retinopathy (PDR), vitrectomy was resorted for non clearing vitreous hemorrhage. Vision improved from a median of 3/60 pre-operatively to 6/6, at 6 months follow up. At 3 months, 2 patients with Eales’ disease, one developed tractional detachment at macula while the other, an epiretinal membrane. No other complications were noted at 6 months.ConclusionNd:YAG laser hyaloidotomy is an inexpensive, effective and a safe outpatient procedure for premacular subhyaloid hemorrhage, producing rapid drainage with restoration of visual function avoiding more invasive procedures and enabling early assessment of the underlying retina. The final visual prognosis however, rests on the underlying cause of the subhyaloid hemorrhage and any accompanying retinal changes.

Induction of Posterior Vitreous Detachment in Pediatric Vitrectomy by Preoperative Intravitreal Injection of Tissue Plasminogen Activator.

To report the efficacy of intravitreal injection of tissue plasminogen activator (tPA) with or without autoserum in induction of posterior vitreous detachment (PVD) in pediatric vitrectomy. Retrospective, interventional case series of pediatric patients receiving intravitreal injection of tPA preoperatively to facilitate PVD in vitrectomy from January 2011 to December 2014 at the Changhua Christian Hospital, Taiwan. All patients received intravitreal injections of 25 µg of tPA 3 days before vitrectomy. For cases without preexisting vitreous hemorrhage, 0.1 mL of intravitreal autologous serum was co-administered. Main outcome measures included successful rate of posterior vitreous detachment in vitrectomy, visual outcome, and related ocular complications. Four boys and 2 girls were included. Ages ranged from 39 weeks' postmenstrual age to 8 years. The indications for vitrectomy were traumatic macular hole (cases 1 and 2); premacular hemorrhage secondary to retinopathy of prematurity (case 3); abusive head trauma with premacular hemorrhage, subinternal limiting membrane hemorrhage, and macular hole (case 4); trauma with dense vitreous hemorrhage (case 5); and vitreous hemorrhage with unknown cause (case 6). Successful PVD was induced intraoperatively in all cases and the macular hole was closed successfully in 3 of 3 cases (cases 1, 2, and 4). No surgical complications were noted. Visual outcome improved in all 3 eyes with checkable preoperative visual acuity (cases 1, 2, and 6). Intravitreal injection of tPA 3 days before vitrectomy may be a helpful adjunct to induce pediatric PVD.

Premaküler Subhiyaloid Hemoraji Gelişen Gebe Hastada Argon Laser Hiyaloidotomi Uygulaması

A 27-year-old female patient had applied to our clinic with a complaint of sudden onset, painless and persistent loss of vision in the left eye starting after an airplane flight 3 days ago. She was 26 weeks pregnant. Visual acuity in the left eye was counting fingers with a normal anterior segment examination. On fundus exam, subhyaloid hemorrhage covering the macular region between the vascular arcades was noticed. After giving information about the pregnancy, complication risks and other treatment alternatives, drainage of the subhyaloid hemorrhage with Argon laser membranotomy treatment was performed. After laser treatment, drainage of the hemorrhage into the vitreous cavity and instant improvement of vision was observed with no complications. The visual acuity was 0.3 (Snellen chart) the following day and 0.9 on the third postoperative day. Premacular hemorrhage was completely drained at one month. No complications were observed on 2 month follow-up. 532 nm lasers are present in most clinics and when proper parameters are selected, it proved to be an effective and safe alternative for treating premacular subhyaloid hemorrhage in our patient.

Successful Resolution of Preretinal Haemorrhage with Intravitreal Ranibizumab

We would like to report two cases of preretinal haemorrhage from two different aetiology courses of bleeding being treated with intravitreal ranibizumab and its outcome. Our first case was a 39-year-old man with a diagnosis of severe aplastic anaemia that presented with bilateral premacular haemorrhages in both eyes. His right eye vision was 6/45 and it was counting finger in the left eye. He was treated with intravitreal ranibizumab once to the right eye and twice to the left eye. Right eye showed complete resolution of premacular haemorrhage and minimal residual premacular haemorrhage in the left eye at 3 months after initial presentation. Our second case was a 32-year-old healthy teacher that presented with preretinal haemorrhage at superotemporal region extending to macular area in left eye secondary to valsalva retinopathy. Her left vision was counting finger. She was treated with single intravitreal ranibizumab to the left eye. There was significant reduction of premacular haemorrhage and her left eye vision improved to 6/6 at 10 weeks after injection. Both cases had favourable outcome with intravitreal ranibizumab and can be considered as nonsurgical treatment option in treating premacular haemorrhage.

Frosted Branch Angiitis Secondary to Familial Mediterranean Fever Resembling Central Retinal Vein Occlusion

Purpose. To report a case of unilateral frosted branch angiitis (FBA) resembling central retinal vein occlusion associated with Familial Mediterranean Fever (FMF). Case Report. A 32-year-old woman presented with progressive, painless vision loss in her left eye lasting for 2 days. She was clinically diagnosed with FMF 2 months ago. The best-corrected visual acuity (BCVA) was 20/20 in her right eye and there was light perception in the left. Ophthalmologic examination revealed severe retinal vasculitis showing clinical features of FBA in the left eye. 64 mg/day oral methylprednisolone was started. A significant improvement in retinal vasculitis was observed in two weeks. However, BCVA did not increase significantly due to subhyaloid premacular hemorrhage. Argon laser posterior hyaloidotomy was performed. One week after hyaloidotomy, visual acuity improved to 20/20 and intravitreal hemorrhage disappeared. Four months after the first attack, FBA recurred. Oral methylprednisolone dosage was increased to 64 mg/day and combined with azathioprine 150 mg. At the end of 12-month follow-up, the BCVA was 20/25 and development of epiretinal membrane was observed in the left eye. Conclusions. Frosted branch angiitis may occur with gene abnormalities as an underlying condition. Our case showed that FMF might be a causative disease.

Nd:YAG Laser Hyaloidotomy for the Treatment of Acute Subhyaloid Hemorrhage: A Comparison of Two Cases.

IntroductionSubhyaloid hemorrhage, whether spontaneous or in the context of a Valsalva maneuver, can lead to an acute decrease in vision when located in the premacular region. Nd:YAG laser hyaloidotomy (NYLH) is a minimally invasive treatment option.MethodsWe examined two different clinical courses based on two case reports of NYLH. One case report described a 52-year-old female patient who presented with a painless decrease of vision to 20/200. The fundoscopy verified a subhyaloid premacular hemorrhage. The precipitating event for the hemorrhage could not be determined, and a NYLH was performed 5 days after the event. The other patient was a 48-year-old man who suffered an acute visual decrease (hand motion) after developing a migraine with vomiting. Fundoscopy showed a dense subhyaloid premacular hemorrhage. NYLH was performed 1 day after the hemorrhage. These clinical courses were documented based on fundus photographs, ultrasounds, and spectral-domain optical coherence tomography (SD-OCT).ResultsIn both cases, there was an effect with approximately 2.2 mJ of laser energy. In the female patient, we observed a gradual but constant increase in vision. After 4 weeks, her vision improved to 20/20. In the male patient, the vision increased to 25/20 1 day after treatment. However, his vision returned to hand motion as he developed a diffuse vitreous opacification. Because of delayed reabsorption, vitrectomy was considered. Since the optical axis was clear with good vision, we decided against this surgery. Complete reabsorption took more than 3 months.ConclusionAfter NYLH for subhyaloid hemorrhage, pronounced vitreous body opacification could develop despite a rapid increase in vision, and requires close monitoring by the surgeon. Fundus photography and SD-OCT are suitable means for clinical course evaluations.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-015-0043-1) contains supplementary material, which is available to authorized users.

Effect of Nd:Yag Laser Hyaloidotomy for Premacular Subhyaloid Haemorrhage

INTRODUCTION: Premacular subhyaloid hemorrhage is a common condition leading to severe sudden vision loss in various conditions.This study investigated the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser treatment. Photodisruption with Zeiss Nd.Yag laser done in the inferior part of the the hemorrhage to create hole in ILM for gravitational drainage of blood in vitreous. A rapid resolution of subhyaloid hemorrhage with improvement of visual acuity was achieved in all patients treated with Nd:YAG laser posterior hyaloidotomy, without evidence of damage to the retina or choroid. Nd:YAG laser posterior hyaloidotomy is simple, effective, safe and non invasive procedure for draining a premacular hemorrhage into the vitreous cavity and to avoid vitreoretinal surgery and complication related to long standing macular toxicity by blood.Journal of Universal College of Medical Sciences Vol. 3, No. 1, 2015: 51-53

Premacular hemorrhage treatment with Nd:YAG laser: A clinical case

IntroductionTo report a case of premacular haemorrhage treated with Neodymium (Nd):YAG laser puncture. Case reportA 54-year-old Caucasian female was seen in the emergency department with complaints of sudden loss of vision in her right eye (RE), detected on the previous day. The best-corrected visual acuity (BCVA) in the RE was reduced to light perception, and fundoscopy evidenced a large and dense premacular haemorrhage.An Nd:YAG laser puncture was performed that day to drain the haemorrhage into the vitreous cavity. The intravitreal haemorrhage cleared in about 1 month, and the BCVA of the RE was 20/25 after 3 months.

Tratamiento con láser Nd:YAG en una hemorragia premacular: caso clínico

IntroductionTo report a case of premacular hemorrhage treated with Neodymium (Nd):YAG laser puncture. Case reportA 54 year-old Caucasian female was seen in the emergency department with complaints of sudden loss of vision in her right eye (RE), detected on the previous day. The best-corrected visual acuity (BCVA) in the RE was reduced to light perception, and fundoscopy evidenced a large and dense premacular hemorrhage.An Nd:YAG laser puncture was performed that day to drain the hemorrhage into the vitreous cavity. The intravitreal hemorrhage cleared in about 1 month, and the BCVA of the RE was 20/25 after 3 months.

Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy

PurposeTo report four cases of premacular hemorrhage secondary to valsalva retinopathy treated with Nd:YAG membranotomy and discuss techniques as well as the literature. DesignRetrospective case series. MethodsA retrospective review was conducted for four patients with vision obstructing hemorrhage secondary to valsalva retinopathy. These patients were all treated with Nd:YAG membranotomy. ResultsFour patients with premacular hemorrhage secondary to valsalva retinopathy were treated with Nd:YAG laser creating a membranotomy to drain the hemorrhage. Power settings ranged from 1.7 to 3.8mJ. Visual acuity at presentation ranged from 20/400 (1 patient) to count fingers (3 patients). Visual acuity improved in three out of four patients after laser treatment. Final visual acuity ranged from 20/20 to 20/30 in these three patients. One patient was lost to follow up after performing laser membranotomy and therefore visual acuity after treatment was not obtained. No complications were noted. ConclusionNd:YAG membranotomy is a non-invasive, office-based treatment option that may be successfully used to treat premacular hemorrhage secondary to valsalva retinopathy.

Natural History of Premacular Hemorrhage Due to Severe Acute Anemia: Clinical and Anatomical Features in Two Untreated Patients

Premacular retrohyaloid hemorrhage is a rare complication of acute severe anemia. The authors report two cases of premacular hemorrhage in which no treatment other than clinical and spectral-domain optical coherence tomography observation was performed. The natural history of this condition reveals that complete clinical resolution is not accompanied by full anatomical restoration. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:E5-E7.].

Outcomes of Double Frequency Nd:YAG Laser Membranotomy for Premacular Haemorrhage Secondary to Valsalva Retinopathy

Purpose: To determine the outcomes of double frequency Nd:YAG laser membranotomy for premacular hemorrhage secondary to Valsalva retinopathy. Methods: Retrospective case series of 24 consecutive patients with premacular hemorrhage of duration less than two months between Jan 2008 and Dec 2012 were included. Patients with any other vascular diseases such as diabetic retinopathy were excluded. The main outcome measure was the best-corrected visual acuity (BCVA) at final follow up. Results: Among 24 patients, majority 16 (67%) were men and all had unilateral Valsalva retinopathy. All patients underwent laser membranotomy using the double frequency Nd:YAG laser on the same day of presentation. The mean age of subjects was 44.03 ± 17.33 years (14-78 years) and the mean duration of symptoms was 10.29 ± 11.7days. The mean follow-up duration was 4.72 ± 2.54 months. All patients presented with blindness or severe vision loss with a mean baseline visual acuity of 1.72 ± 0.58 logMAR (Snellen’s equivalent 20/1050; range 0.17-2.3). Significant improvement of visual recovery was noted in 91.66% of patients at 1 month (mean final BCVA 0.20 ± 0.56 logMAR (Snellen’s equivalent 20/30; range 0-2.3 logMAR). Twenty-two (91.66%) patients were successfully treated with laser alone. No complications were noted. Two patients underwent vitrectomy and achieved 20/20 visual acuity. Conclusion: Prompt treatment using the frequency doubled Nd YAG laser appears to be safe and effective in achieving significant visual recovery in patients with premacular hemorrhage due to Valsalva retinopathy.

Macular Hole Formation after Pars Plana Vitrectomy for the Treatment of Valsalva Retinopathy: A Case Report

We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.

Pre-macular hemorrhage in chronic malaria.

Pre-macular hemorrhage in chronic malaria.

Role of optical coherence tomography in posterior segment eye disorders: A review of two cases

Optical Coherence Tomography produces high resolution tomographic in in vivo imaging of biological tissues. The study reviews OCT images of two patients with varied retinal pathologies to determine its usefulness in aiding evaluation and management of retinal diseases. The patients were imaged using OCT conventional fundus photography and angiography. A case each of premacular haemorrhage and idiopathic polypoidal choroidal vasculopathy, are presented highlighting the merits of OCT. OCT establishes the accurate diagnosis of retinal diseases and in monitoring response to therapy. It is complementary to clinical techniques of direct and indirect ophthalmoscopy, conventional fundus photography, fluorescein and indocyanine green angiography thus should be made readily available for use in the evaluation of retinal disorders to enhance their management.

High-Power Handheld Blue Laser-Induced Maculopathy: The Results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group

To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser. Consecutive case series. Fourteen eyes of 14 patients. Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150-1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography. Analysis of the types of maculopathy and vitreoretinal pathologic features. All patients were young males. 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. Best-corrected Snellen visual acuity 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. The latter consisted of neodymium:yttrium-aluminum-garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15-20/300). 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.

Late spectral-domain optical coherence tomography findings in sub-internal limiting membrane hemorrhage.

To report spectral-domain optical coherence tomographic (OCT) findings during the natural history of a sub-internal limiting membrane (sub-ILM) hemorrhage. Observational case report of a 20-year-old man with myeloid acute leukemia who presented a spontaneous resolution of a premacular hemorrhage, which was demonstrated by OCT. During the 12-month follow-up, periodic ophthalmologic and OCT examinations were performed. A premacular hemorrhage was revealed in fundus examination, and spectral-domain OCT demonstrated a highly hyperreflective band just above the premacular hemorrhage consistent with the ILM. At 6-month follow-up, the macula was free of blood. The OCT scans after spontaneous resolution of the hemorrhage showed a thickened hyperreflective membrane (ILM) and a prominent hyporeflective premacular cavity. Six months later, this premacular cavity had resolved. These late OCT findings in sub-ILM hemorrhage have not been described in spontaneous evolution and confirm the sub-ILM location of a premacular hemorrhage.