Subhyaloid Hemorrhage Research Articles

Spectral Domain Optical Coherence Tomography for Proliferative Diabetic Retinopathy with Subhyaloid Hemorrhage

A prototype 6-microm axial resolution spectral domain optical coherence tomography (SD-OCT) device was used to image the retina of a patient with uncontrolled diabetes mellitus who had proliferative diabetic retinopathy with subhyaloid hemorrhage. A raster scan pattern with 128 B-scans covering a 6 X 6 X 2-mm volume of the retina was obtained. SD-OCT showed the presence of blood localized between the internal limiting membrane and the posterior hyaloid face and allowed visualization of the cross sectional retinal architecture and the vitreoretinal interface at different horizontal levels that could be registered with the color fundus photograph. SD-OCT provided useful information about the relationship of the hemorrhage to the posterior hyaloid and the retina.

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.

Retinal Arterial Macroaneurysm Rupture Following Fundus Fluorescein Angiography and Treatment With Nd:YAG Laser Membranectomy

A 60-year-old woman with hypertension was seen for a routine examination. Her best-corrected visual acuity was 20/20 bilaterally. Intraretinal hemorrhages were found in the parafoveal region of the right eye. A fundus fluorescein angiography evaluation identified the hemorrhages as arterial macroaneurysms. The following day, the patient returned complaining of blurred vision that had developed the previous evening. Best-corrected visual acuity was counting fingers in the right eye. A subhyaloid hemorrhage approximately three optic disks in size was found in the macular region. The hemorrhage was drained with an Nd:YAG laser.

Rapid resolution of premacular haemorrhage after Nd:YAG laser posterior hyaloidotomy

1 week after sudden, painless visual loss in the left eye. He had no systemic illness and no previous trauma, pain or redness in the left eye. Visual acuity (VA) was 6 ⁄ 6 in the right eye and hand movements (HM) in the left. Dilated fundal examination revealed a large preretinal haemorrhage about 10 disc diameters in size in the left eye, obscuring the macular area (Figs 1A, 2A). No source of haemorrhage such as proliferative diabetic retinopathy, macroaneurysm or choroidal neovascularization was found. The patient was treated with Nd:YAG laser posterior hyaloidotomy (VISULAS YAG11 plus; Zeiss). The beam was focused on the posterior hyaloid membrane and a single 7.4-mJ burst was used, after which the blood began to drain from the preretinal haemorrhage into the vitreous cavity (Figs 1B, 2B). Drainage of the blood into the vitreous cavity was completed within 10 mins and VA in the left eye improved dramatically from HM to 6 ⁄ 6 (Figs 1C, D and 2C, D). There were no complications as a result of the laser treatment. The blood in the vitreous resolved spontaneously over a period of 2 months and the patient was asymptomatic at the last followup visit. Premacular subhyaloid haemorrhage may be secondary to Valsalva retinopathy, proliferative diabetic retinopathy, central retinal vein occlusion, retinal macroaneurysm, Terson’s syndrome, blood dyscrasia and blunt ocular trauma (Raymond 1995; Ulbig et al. 1998; Celebi & Kukner 2001; Rennie et al. 2001). The haemorrhage usually resolves spontaneously and

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy. Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months. All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage. Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.

Valsalva-like Retinopathy Following Hyperopic Laser In Situ Keratomileusis

<P> A 50-year-old woman presented with unilateral acute loss of vision 15 hours after undergoing bilateral hyperopic laser in situ keratomileusis (LASIK). She denied “straining.” Fluorescein angiography showed no retinal vascular abnormalities but demonstrated blocked fluorescence corresponding with subhyaloid, intraretinal, and subretinal hemorrhages seen clinically in the left eye. YAG laser vitreolysis was performed after noting posterior cortical vitreous thickening with a loculated subhyaloid hemorrhage. Best spectacle-corrected visual acuity was restored to 20/20 by the 2-month follow-up examination. Valsalva-like retinopathy, possibly the result of the rapid rise and fall of intraocular pressure during the microkeratome and suction ring operation, may occur following hyperopic LASIK surgery. [<CITE>Ophthalmic Surg Lasers Imaging</CITE> 2006;37:486-488.] </P> <H4>AUTHORS</H4> <P>From the Department of Ophthalmology (AAM, PJF), North Shore University Hospital, Great Neck, New York; Kaiser Permanente (SAH), Oakland, California; the Department of Ophthalmology (DZR), Weill Medical College, Cornell University, New York, New York; Reinstein Institute (DZR), London, United Kingdom; and Long Island Vitreoretinal Consultants (PJF), Great Neck, New York. Dr. Moshfeghi is currently affiliated with the Bascom Palmer Eye Institute, Miami, Florida. </P> <P>Accepted for publication November 20, 2005. </P> <P>Presented in part at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, November 11-14, 2001. </P> <P>Address reprint requests to Philip J. Ferrone, MD, 600 Northern Boulevard, Suite 216, Great Neck, NY 11021. </P>

A Case of Valsalva Retinopathy Associated with Straining at Stool

The Valsalva maneuver is described as an expiratory effort against a closed glottis or airway. It leads to elevation of retinal venous pressure and may result in retinal hemorrhage. A fifty two- year-old man presented with an acute reduction of central visual acuity in his right eye which occurred after considerable straining at stool. Detailed past medical history revealed that he suffered from chronic constipation and hypertension. There were one disc sized subhyaloid hemorrhage and three small intraretinal hemorrhages around the fovea at the dilated fundus examination. After three months of follow-up without any treatment, the retinal hemorrhages resolved without any sequelae. Here we report a patient with sudden visual loss and retinal hemorrhage.

Subinternal limiting membrane and subhyaloid haemorrhage in Terson syndrome: the macular ‘double ring’ sign

Subinternal limiting membrane and subhyaloid haemorrhage in Terson syndrome: the macular ‘double ring’ sign

Massive subhyaloidal hemorrhage associated with severe PAI-1 deficiency

To report an association between spontaneous subhyaloidal hemorrhage and severe plasminogen activator inhibitor-1 (PAI-1) deficiency. Case report. A 29-year-old woman presented with sudden, painless visual loss to hand motion in her right eye. Ophthalmoscopy showed a massive subhyaloidal hemorrhage. The patients' medical history was negative for cardiovascular risk factors, trauma, infections or bleeding complications. Further investigation into possible causes revealed hyperfibrinolysis secondary to severe PAI-1 deficiency. The non-clearing subhyaloidal hemorrhage was successfully treated by pars plana vitrectomy, and her visual acuity improved to 20/20. When ordering laboratory tests in patients with spontaneous subhyaloidal hemorrhage to rule out fibrinolytic disorders, severe PAI-1 deficiency should be considered in the differential diagnosis. Selective screening may be helpful in identifying ophthalmologic patients with hyperfibrinolysis, especially in young individuals with subhyaloidal hemorrhages in the absence of other recognized risk factors.

Macular hole and subhyaloid hemorrhage following filtering surgery with mitomycin C

We report the occurrence of a macular hole with sub-hyaloid hemorrhage following filtering surgery with mitomycin C. Combined trabeculotomy and trabeculectomy with mitomycin C was performed in the left eye for primary congenital glaucoma. Two weeks postoperatively the fundus showed a macular hole with subretinal and retinal hemorrhage along with sub-hyaloid bleeding. Optical coherence tomography confirmed the presence of a full-thickness macular hole. A full-thickness macular hole with subretinal and retinal hemorrhage is reported as a complication of glaucoma filtering surgery.

Optic Neuritis, Preretinal Hemorrhage, and Retinal Vasculitis as Ocular Manifestations of Brucellosis

A young woman with severe visual loss, diplopia, bilateral optic nerve swelling, subhyaloid hemorrhage, and vasculitis was diagnosed with brucellosis. Clinical and ocular findings, except optic disc atrophy, improved within 3 months after antibrucellar treatment. These findings expand the ocular manifestations of brucellosis, and should be considered in the differential diagnosis of optic neuritis, subhyaloid hemorrhage, vasculitis, and optic disc atrophy.

Premacular haemorrhage associated with arteriovenous communications of the retina induced by a valsalva-like mechanism: An observational case report

A 26-year-old woman presented with sudden defective vision in the right eye following lifting a heavy bucket of water. Examination showed a dense premacular subhyaloid haemorrhage associated with arteriovenous communications of the retina (AVCRs). Spontaneous absorption of the premacular haemorrhage with consequent improvement in the visual acuity was seen after two months. The possible aetiopathogenesis of the case is also discussed.

Subhyaloid Hemorrhage Treated With SF 6 Gas Injection

A 72-year old woman with a premacular subhyaloid hemorrhage could not be treated by laser photodisruption due to a thick posterior cortical vitreous. Pure sulfur hexafluoride (SF6, 0.3 mL) gas was injected intravitreally without recombinant tissue plasminogen activator, and facedown positioning was recommended for 5 days. Posterior vitreous detachment was induced and the hemorrhage dispersed into the vitreous cavity. Eight weeks later, her visual acuity had recovered from hand motions to 20/40. Fluorescein angiography revealed an arterial macroaneurysm in the inferotemporal retina. Intravitreal SF6 gas injection without recombinant tissue plasminogen activator may be an alternative method for treating a relatively new subhyaloid hemorrhage.

Bilateral subhyaloid haemorrhage in aplastic anaemia

Bilateral subhyaloid haemorrhage in aplastic anaemia

Hemorragia subaracnóidea e síndrome de Terson: estudo prospectivo

PURPOSE: To analyze the incidence, clinical course, ophthalmic findings, and prognosis of the patients with intracranial bleeding and Terson's syndrome. METHODS: A prospective consecutive study of patients admitted to the emergency room with the diagnosis of acute subarachnoid hemorrhage. Neurological and funduscopic examinations were performed upon admission and at days 3, 7, 30 and 60 after the diagnosis. In all cases the clinical condition was graded according to the Hunt and Hess classification. RESULTS: Seventeen patients were enrolled in this study from July to October, 2000. Terson's syndrome was diagnosed in 5 of the patients (29.4%). Fifteen cases were associated with ruptured cerebral aneurysms, and the remaining two were caused by head trauma. There was no gender preponderance (9F:8M) and the median age was 48 years (range 22-80 years). Four of the five patients (80%) with Terson's syndrome died from intracranial complications, whereas 11 patients with intracranial bleeding and no ocular involvement survived. The leading cause of mortality was rebleeding. The ophthalmoscopic findings included intraretinal bleeding (3 cases), intraretinal and with subhyaloid hemorrhage (1 case) and intraretinal hemorrhage with cotton wool spots (1 case). CONCLUSIONS: In our study, the incidence of Terson's syndrome was 29.4% and it was associated with a high mortality rate (80%).

Photodisruptive Nd:YAG laser in the management of premacular subhyaloid hemorrhage.

Premacular subhyaloid hemorrhage is usually a benign condition that generally improves spontaneously and rarely causes visual loss. However, because the hemorrhage may cause permanent macular changes before it resolves, Nd:YAG laser posterior hyaloidotomy may be indicated in selected cases. This study investigated the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser treatment. This study was conducted between February 1996 and March 1999. Six patients had a circumscribed premacular hemorrhage in one eye and were treated with the Nd:YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from Valsalva retinopathy (2 cases), proliferative diabetic retinopathy (2 cases), central retinal vein occlusion (1 case), and blunt ocular trauma (1 case). The size of the hemorrhage is expressed in disc diameters. The mean pretreatment hemorrhage measured 5.7 disc diameters (range 3.5-8.0). Visual acuity in all cases before laser treatment was hand movement. After laser treatment, the hemorrhage instantly drained into the vitreous cavity, resulting in rapid improvement of vision. Drainage was complete within one week and visual acuity improved dramatically. The mean follow-up was 26.3 months (range 7-42 months). No retinal damage or rebleeding occurred due to the laser treatment, and vitrectomy was not required in any eye. Nd:YAG laser posterior hyaloidotomy may be useful for draining a premacular hemorrhage into the vitreous cavity in selected cases. To establish this as a routine procedure, a randomized prospective study is needed to compare observation, primary vitrectomy, and Nd:YAG laser treatment.

Argon laser therapy for subhyaloid hemorrhage in pregnancy

An extensive subhyaloid hemorrhage covered the posterior pole of 1 eye in a 30-year-old pregnant woman after an incident of severe vomiting. Argon laser posterior hyaloidotomy was performed. Visual acuity improved from counting fingers to 6/6 on the fourth day and remained unchanged after 1 year, without visible retinal damage. Although the indications are rare, argon laser therapy should be considered for subhyaloid hemorrhage when a rapid restoration of visual acuity is desired.

Diagnosis of retinal arterial macroaneurysm presenting as subhyaloid hemorrhage by indocyanine green videoangiography

A 66-year-old hypertensive woman complained of sudden loss of vision in her left eye. The clinical examination disclosed a subhyaloid hemorrhage obscuring the fovea. Fluorescein angiography showed a hyperfluorescent spot under the hemorrhage, but details were obscured. Indocyanine green videoangiography revealed a retinal arterial macroaneurysm as the cause of bleeding. Indocyanine green videoangiography appears to be useful in the diagnosis of retinal arterial macroaneurysm obscured by preretinal hemorrhage.

Intraocular hemorrhages associated with endoscopic spinal surgery

PURPOSE: To report the occurrence of intraocular hemorrhages in association with endoscopic spinal surgery. METHODS: Case report. RESULTS: A 40-year-old patient noted severe visual loss in both eyes after epidural endoscopy, epidurography, and endoscopic adhesiolysis. Ophthalmic examination showed a best-corrected visual acuity of RE: 20/800, and LE: counting fingers, and extensive subhyaloid, retinal, and subretinal hemorrhages in both eyes. The hemorrhages resolved over a period of 8 weeks and the best-corrected visual acuity improved to 20/40 in both eyes after 4 months. CONCLUSION: A syndrome of visual loss and intraocular hemorrhages after an endoscopic spinal procedure is studied.