Premacular Subhyaloid Hemorrhage Research Articles

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

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

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.

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.

A COMPARATIVE STUDY BETWEEN EARLY VERSUS DEFERRED VITRECTOMY IN MANAGEMENT OF UNCOMPLICATED DIABETIC VITREOUS HAEMORRHAGE

Objective: To determine the visual outcome and frequency of complications after pars planavitrectomy in cases of diabetic vitreous hemorrhage underwent early (within one month ofonset) versus delayed vitrectomy (after one month of onset). Patients and Methods: Thirtyeyes of 30 diabetic patients presented by uncomplicated diabetic vitreous haemorrhage divided intotwo groups; each group consists of fifteen eyes. Group Aincluded the patients presented bydiabetic vitreous haemorrhage and undergone early vitrectomy within one month of onset.Group B included the patients presented by diabetic vitreous haemorrhage after one month ofonset and undergone delayed vitrectomy after one month of onset. Results: In group A, we foundpostoperative visual acuity ranges from 6/60 to 6/12 (1.00 to 0.30 Log MAR) with mean 0.58 (LogMAR). In group B postoperative visual acuity ranges from 3/60 to 6/18 (1.30 to 0.48 Log MAR) withmean 0.75 (Log MAR). Patients of type I DM underwent early vitrectomy have 0.62 (Log MAR)final mean BCVA, while those underwent delayed vitrectomy have 0.75 (Log MAR) final meanBCVA. P-value (0.04) shows statistical significance among both groups. Patients of type II DMunderwent early vitrectomy have 0.56 (Log MAR) final mean BCVA, while those underwent delayedvitrectomy have 0.75 (Log MAR) final mean BCVA, P-value (0.42) shows statistical significance. Themean first day IOP was 19.13 mmHg in group A vs 17.8 mmHg in group B. No patients in group A had a first day IOP recorded above 23 mmHg. In group B, however, two patients had a 1st dayIOP above 23 mmHg and required a short course of oral acetazolamide and topical antiglaucomamedications. In contrast, three patients had postoperative hypotony (IOP<10mmHg) in group Acompared to one patient in group B. However, at the 1st week follow-up appointment all IOPs had returnedto within normal limits. P-value (0.364) shows no statistical significance among both groupsConclusion: Visual results after PPV in diabetic vitreous hemorrhage show that most of patients regainor retain useful vision. Early vitrectomy with endolaser retinal photocoagulation for diabetic vitreoushaemorrhage (<30 days) decreases time spent with vision loss and the need for adjunctive PRPespecially in patients of type I DM, recurrent vitreous haemorrhage and cases of premacular subhyaloidhaem-orrhage. A few proportions of patients may develop late complications like recurrentvitreous hemorrhage and retinal detachment after successful PPV requiring secondaryintervention.

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.

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.

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.

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.

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

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.

Premacular Subhyaloid Haemorrhage Drainage by Frequency-Doubled (532 nm) Nd:YAG Laser

Premacular Subhyaloid Haemorrhage Drainage by Frequency-Doubled (532 nm) Nd:YAG Laser

Evaluation of pulsed Nd:YAG laser posterior hyaloidotomy as an emergency treatment for blinding premacular subhyaloid hemorrhage.

Purpose:This study aimed to evaluate the benefits of Nd:YAG laser posterior hyaloidotomy as a method allowing rapid drainage of subhyaloid hemorrhage into the vitreous gel.Design:Nonrandomized, prospective, interventional, controlled case series.Methods:Nd:YAG laser posterior hyaloidotomy was performed in four eyes of three patients with premacular subhyaloid hemorrhage. The etiologies were bleeding tendency, proliferative diabetic retinopathy, and idiopathic. Four eyes of four patients with premacular subhyaloid hemorrhage were managed conservatively. The etiologies were proliferative diabetic retinopathy and Valsalva retinopathy.Results: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. With regard to the conservatively managed eyes, there was a tendency towards slow spontaneous absorption of hemorrhage during the follow-up period.Conclusion:Nd:YAG laser posterior hyaloidotomy was a safe and effective procedure for rapid resolution of premacular subhyaloid hemorrhage, allowing rapid restoration of visual acuity, visualization of the underlying retina, expedited access for macular photocoagulation and avoidance of vitrectomy.

Nd:YAG Laser for Treatment of Premacular Subhyaloid Hemorrhage

Nd:YAG Laser for Treatment of Premacular Subhyaloid Hemorrhage

Premacular subhyaloid haemorrhage in Eales' disease managed with Nd:YAG laser

Premacular subhyaloid haemorrhage in Eales' disease managed with Nd:YAG laser

SUDDEN VISUAL LOSS IN ACUTE LEUKAEMIA

The presenting signs of acute leukaemia occur as a result of bone marrow failure and organ in' ltration. Increased bleeding tendencies are seen on the skin, gums and mucosal lining. Bleeding in the posterior segment of the eye, namely the retina and vitreous, may occur, but do not usually cause any visual disturbances. This case demonstrates visual loss as a result of premacular subhyaloid haemorrhage in acute leukaemia.

Pneumatic displacement without tissue plasminogen activator in premacular subhyaloid hemorrhage

To assess the efficacy and safety of intravitreal injection of Sulfur Hexafluoride (SF6) gas without the use of tissue Plasminogen Activator (tPA) in premacular Subhyaloid Hemorrhage ( SHH ), 5 eyes of 5 patients with premacular SHH were enrolled. After performing paracentesis of the anterior chamber, 0.3 ml pure SF6 gas was injected through pars plana with a 30 gauge needle. Facedown position was maintained for 5 days. Subhyaloid Hemorrhage was displaced in 4/5 ( 80% ) eyes with a duration of SHH less than 2 weeks. The pre-injection visual acuity of all 5 eyes was finger counting and improved in 4/5 ( 80% ) eyes within 3 days to 7 days post-injection to 6/20 - 6/6. The underlying disease was hypercoagulation in 1 patient , diabetes mellitus in 2 patients , hypertension in 1 patient and unknown in 1 patient. No complications were encountered. In conclusion, SF6 gas injected into the vitreous without the use of tPA, can displace SHH if performed within 14 days of duration, and results in rapid visual recovery. This procedure is proven to be safe. (Med J Indones 2007; 16:104-7)

Aspects cliniques et évolutifs des hémorragies maculaires secondaires à un macroanévrysme artériel rétinien

Retinal arterial macroaneurysm (RAM) is an acquired vascular retinal abnormality that has developed from a retinal arterial branch located in the macular area. It is responsible for decreased visual acuity when complications such as bleeding or retinal exudation occur. A ruptured RAM leads to severe premacular, submacular, or vitreous hemorrhage. The progression can be spontaneously favorable depending on the severity and the location of the hemorrhage. A poor visual prognosis is usually reported in subretinal hemorrhage. We reported the observation of four patients with macular hemorrhage secondary to ruptured RAM. Four patients--two males and two females, aged from 39 to 65 years, presented with sudden unilateral decreased visual acuity. An ophthalmologic exam with visual acuity measurement, anterior segment exam, ocular tonometry, and funduscopy was performed, completed with fluorescein retinal angiography. A Nd:Yag laser hyaloidotomy was done in two cases of premacular hemorrhage 1 week after its occurrence. Submacular hemorrhages were only observed using visual acuity measurement and ophthalmoscopic examination. The follow-up is 3-4 months. Initial visual acuity varied from light perception to 2/10. The fundus examination showed a macular hemorrhage: subretinal in one case, preretinal in two cases, and in the last case the hemorrhage was both preretinal and subretinal. The diagnosis of MAR was confirmed by fluorescein angiography, which showed a hyperfluorescent arterial dilatation temporal to the macula. In the cases of submacular hemorrhage, the hemorrhage reduced spontaneously after simple monitoring. Final visual acuity was 4/10 and 5/10. For premacular subhyaloid hemorrhage treated with laser Nd:Yag drainage, the final visual acuity was 5/10 and 7/10. Visual prognosis in premacular hemorrhage is improved by Nd:Yag laser treatment. Subretinal hemorrhage can have a spontaneous favorable outcome. Surgery should not be systematic. Comparative studies are necessary to apply indications.