YAG Laser Hyaloidotomy Research Articles

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.

Nd:YAG laser hyaloidotomy for treatment of subhyaloid hemorrhage in pregnancy

Background: To report a pregnant patient with impaired vision due to macular involvement of valsalva retinopathy associated with subhyaloid hemorrhage, who was effectively treated with Nd:YAG laser hyaloidotomy and led to successful visual recovery. Case presentation: A thirty-year-old pregnant woman at 36- week gestational age was referred due to suddenly decreased visual acuity in her left eye following a severe vomiting. Left eye examination showed a dense large subhyaloid hemorrhage in front of macula extending from superior to inferior arcade with a clear media. With the diagnosis of subhyaloid hemorrhage she underwent Nd:YAG laser hyaloidotomy and visual acuity improved from hand motion to 20/20 after one week. Conclusion: In this report, Nd:YAG laser hyaloidotomy was shown to be effective and safe in treatment of dense subhyaloid hemorrhage in pregnant patients with Valsalva retinopathy. Keywords: Nd:YAG laser hyaloidotomy; subhyaloid hemorrhage; pregnancy; valsalva retinopathy.

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.

Clinical variations and therapeutic challenges in the management of symptomatic retinal artery macroaneurysm: a tertiary center experience.

To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients. Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46years ± 14.89 (SD) fulfilled the inclusion criteria. Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29(±0.35) to 0.75(±0.15) p value 0.66 in Nd: Yag laser group, 2.67(±0.58) to 0.46(±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case. With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.

Larétinopathie de Valsalva et le travail d’accouchement au CHU-IOTA

Valsal va retinopathy occurs when superficial retinal capillaries are disrupted due to intraocular hyperpressure following a sudden increase in intrathoracic or intra-abdominal pressure. One patient of 24 had a sudden drop in visual acuity in her left eye during labor. The yag laser hyaloidotomy allowed a complete resorption of the haemorrhage and a clear improvement of visual acuity. The closed glottis push technique or vasalva maneuver during labor seems to be a risk factor for pre-retinal haemorrhage.

Full-thickness retinal hole after nd:yag laser hyaloidotomy treatment of subhyaloid hemorrhage secondary to valsalva maneuver

Full-thickness retinal hole after nd:yag laser hyaloidotomy treatment of subhyaloid hemorrhage secondary to valsalva maneuver

Valsalva retinopathy: Long-term results and management strategies.

To investigate the long-term results and efficacy of the treatment modalities for preretinal hemorrhage due to valsalva retinopathy. Retrospective review was conducted on 24 eyes of 24 patients with valsalva retinopathy who were treated between 2004 and 2019. These patients were treated with Nd:YAG laser, argon laser and vitrectomy or were only observed. Nd:YAG laser hyaloidotomy was performed in 10 eyes, argon laser was applied to two of those following failed Nd:YAG laser, and vitrectomy was performed in one eye. A conservative approach was adopted in 13 eyes. There were 15 females and nine males with mean age of 41.08 ± 12.72 (21-65) years. Mean follow-up period was 42.83 ± 23.78 (range: 12-116) months. Patients with hemorrhage size smaller than or equal to 4-disc diameter were observed for spontaneous resorption and achieved 20/20 visual acuity within 6 months. Visual acuity of all patients treated with Nd:YAG and/or argon laser, increased within the first week after the treatment. Vitrectomy was performed in only one patient with hemorrhage located away from macula. The good visual outcomes were achieved in all treatment modalities. Observation, Nd:YAG laser and argon laser seem to be safe and effective approaches for eyes with valsalva retinopathy. The size, volume and duration of hemorrhage are the most crucial factors for treatment choice, success and complications.

Nd:YAG Laser Hyaloidotomy for Premacular Hemorrhage in Diabetic Eyes

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Factors Impacting Outcomes and the Time to Recovery From Malignant Glaucoma

To identify factors associated with the successful treatment of malignant glaucoma (MG). Retrospective case series. Setting: single institution; study population: 64 eyes (55 subjects) with MG; observation procedure(s): chart review; main outcome measures: anatomy, intraocular pressure (IOP), best visual acuity (BVA). 87.5% (n=56/64) of eyes with MG required surgical intervention. Vitrectomy was more likely to be successful in eyes with a history of <3 incisional surgeries, <3 glaucoma drops, or IOP ≤30mm Hg (P < .05). If vitrectomy was performed within 30days, recovery of anatomy, BVA, and IOP occurred sooner (P < .05). IOP reduction was greater in subjects treated with oral carbonic anhydrase inhibitors (P=.016) or Nd:YAG laser hyaloidotomy (P = .007), and without a history of MG (P=.007). Time to maximal improvement was significantly longer for IOP and BVA than anatomy (P < .001). Treatment of MG with an oral carbonic anhydrase inhibitor hastened anatomic recovery (P= .01). Time to improvement in BVA was significantly faster in menand African Americans (P < .05). Time to maximalreduction in IOP occurred sooner in eyes that underwent anterior chamber reformation in clinic (P < .002). Trabeculectomy surgery prior to MG was associated with prolonged recovery of anatomy, BVA, and IOP (P < .05). Earlier vitrectomy may shorten recovery times for MG. Nd:YAG laser hyaloidotomy and oral carbonic anhydrase inhibitors may lead to greater IOP reduction. The time to maximal improvement in IOP and BVA may be longer than the time to anatomic resolution. Although trabeculectomy may impede time to recovery from MG, oral carbonic anhydrase inhibitors may shorten the time to anatomic recovery and anterior chamber reformation may hasten IOP recovery.

ИАГ-лазерная гиалоидотомия в лечении премакулярных кровоизлияний

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

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

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

Angiographic features and disease outcomes of symptomatic retinal arterial macroaneurysms.

Symptomatic retinal arterial macroaneurysms (RAM) are primarily investigated by fundus fluorescein angiography after presenting with visual disturbance. The natural history includes spontaneous regression and occasionally occlusion of the arteriole distal to the aneurysm. RAM may be managed conservatively. Interventional treatment options include focal argon laser photocoagulation, Nd:YAG laser hyaloidotomy, and pars plana vitrectomy. The purpose of this study was to elicit the rates of distal vessel occlusion and aneurysm thrombosis in RAM at presentation, and their relevance to the treatment of RAM. Furthermore, visual outcomes were examined. Retrospective review of cases of RAM presenting to a tertiary ophthalmology care centre was accomplished in a university teaching hospital. The angiographic features, treatment indications, and visual outcomes in patients with RAM were recorded. Angiographic features noted were distal vessel patency and aneurysm thrombosis at presentation. Ten patients with RAM were identified. Ninety percent had an angiographically patent distal arteriole, with 40% showing spontaneous thrombosis of the aneurysm sac at presentation. Patients presenting with a spontaneously thrombosed RAM were managed conservatively, those with flow within the aneurysm wall were treated with focal laser, and those with subhyaloid haemorrhage underwent Nd:YAG laser hyaloidotomy. LogMAR visual acuity improved from 0.3 (±0) at presentation to 0.15 (±0.1) in the conservative group, and from 0.78 (±0.23) to 0.24 (±0.18) in those who underwent one intervention. One patient lost vision after multiple RAM. Thrombosis within the aneurysm wall is an important feature in deciding to treat RAM, and selective use of interventions improves vision in affected patients.

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.

Management strategies in malignant glaucoma secondary to antiglaucoma surgery.

To assess the outcomes of various interventions for malignant glaucoma (MG). A retrospective, comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan. 2009 and Dec. 2012. Numerous treatments were administered including medical therapy, neodymium: yttrium- aluminium-garnet (Nd:YAG) laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options. The characteristic, treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo. Four eyes of 3 patients achieved complete resolution with medical therapy. Nd:YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes, both of which achieved resolution after initial intervention. Thirty-two eyes were given surgical treatments with anterior vitrectomy- reformation of anterior chamber in 13 eyes, phacoemulsification- intraocular lens implantation in 10 eyes and phacoemulsification- intraocular lens implantation- anterior vitrectomy in 9 eyes. Resolution of MG was seen in almost all patients. The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit. The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm. Twenty eyes with preoperative visual acuity better than counting figure/ 50 cm had various visual improvements. Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity, corneal endothelial decompensation and allergic to atropine respectively. MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment, laser therapy is beneficial in pseudophakic eyes, and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management. MG can be managed successfully by appropriate and timely interventions with good visual outcome.

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.

Management of Macular Pre-Retinal Subhyaloid hemorrhage by Nd:Yag laser hyaloidotomy.

To evaluate the efficacy, visual outcome and complication following Nd:Yag laser hyaloidtomy for subhyaloid hemorrhage. This interventional case series was managed at LRBT, Free Base Eye Hospital Karachi from January 2010 to December 2010. It included 30 eyes of 30 patients with subhyaloid hemorrhage due to different causes which underwent Nd: Yag laser sublyaloidotomy Results: Out of thirty patients, eighteen (60%) were male and twelve (40%) were females. Mean age was 32.57 years. Males pre-dominated the study. Pre laser visual acuity was between counting finger at one meter in 22 patients (73.33%) and between counting finger one meter to hand movement in 8 patients (26.66%). Vision improved to 6/6 in 10 patients (33%), 6/9 - 6/12 in 17 patients (56.66%) and between 6/24 - 6/60 in 3 patients (9.99%) at the end of follow up. Complications were persistent vitreous hemorrhage in one (3.33%) patient, failed drainage in one (3.33%) patient and metamorphopsia in one (3.33%) patient. Nd: Yag laser hyloidotomy is an excellent technique for management of Subhyaloid hemorrhage with early visual recovery provided there is no macular pathology.

Valsalva Retinopathy in Pregnancy: SD-OCT Features During and After Nd:YAG Laser Hyaloidotomy

Valsalva retinopathy can present as a sudden, dramatic loss of central vision due to the premacular location of the resultant subhyaloid hemorrhage. Certain vascular conditions predispose to the condition and occasional reports exist of Valsalva retinopathy in pregnancy. The authors describe a case of Valsalva retinopathy in a pregnant patient in terms of the physical features present that led to making the decision to treat by Nd:YAG laser hyaloidotomy as opposed to conservative management. Spectral-domain optical coherence tomography (SD-OCT) was able to demonstrate the physical features of the lesion prior to, immediately after, and weeks after treatment, and showed not only the dispersion of hemorrhage into the vitreous cavity from the subhyaloid space, but also that the subhyaloid cavity dimensions were unchanged despite release of the hemorrhage. SD-OCT visualized the actual hyaloidotomy site and its subsequent closure, which has not previously been reported in the literature.

Reply to Athanasiadis et al

Sir, We are grateful to Dr Athanasiadis et al1 for their interest in our manuscript,2 and for this opportunity to reiterate the points made therein. Zonular disruption during laser peripheral iridotomy (LPI) can occur if sufficient energy is applied or if there is pre-existing zonular weakness. Indeed, Nd:YAG laser zonulotomy and hyaloidotomy are used in the management of some cases of aqueous misdirection syndrome. However, in our experience from the specialist angle-closure clinic at Moorfields City Road, the Zhongshan Angle-closure Prophylaxis (ZAP) study in Guangzhou, China (ISRCTN45213099), and our research programme in Mongolia, culminating in over 4500 LPIs and 800 phacoemulsification procedures in the same pool of patients, we have not encountered this problem with LPI. Dr Athanasiadis's case report3 omits to mention where the initial phaco wound was (ie superior or temporal). This may have some bearing on the location of the dehiscence. The report also does not mention the power and number of shots during LPI. We were puzzled as to why two iridotomies were performed in each eye of the patient reported in this case. One adequately sized iridotomy is sufficient in management of angle closure. Angle closure is known to affect people with a variety of genetic mutations that cause zonular abnormalities and weakness as part of their phenotype: PXF, FBN1 (Marfan and Weill Marchesani syndromes), lysyl hydroxylase (Ehler Danlos VI), MTHFR (homocystinuria), and ADAMTS4 and ADAMTS10 (spherophakia). As per the principles of Occam's razor, we would suggest that the case Dr Athanasiadis et al report had a pre-existing zonular weakness and/or received higher-than-usual amounts of laser energy. It is important to emphasise that LPI should be performed by a skilled, experienced operator, using the lowest possible power to achieve a satisfactory iridotomy. We would advocate the use of sequential argon/YAG iridotomy in patients with thick, dark brown irides.4 Regarding the risk of cataract formation/progression after PI, similar principles to those outlined above apply. With excess power or inappropriately applied laser treatment, it is possible to induce lens opacities, but this can be avoided with careful and precise treatment. Studies suggesting that LPI accelerates the formation of age-related cataract are exclusively retrospective studies, or individual case reports. Some have used surrogate outcome measures, such as reduction in visual acuity, rather than lens opacity grading. We believe that our study,2 which was carried out prospectively, in the largest number of treated cases so far studied, with a control group selected from the community, using a standardized objective assessment of lens opacity (LOCS III system), currently constitutes the most robust scientific assessment of the risk of lens opacity after laser iridotomy. The choice of either laser iridotomy or lens extraction for management of angle-closure glaucoma should be informed by the ongoing MRC EAGLE trial (https://viis.abdn.ac.uk/HSRU/eagle/). We are grateful to the journal for giving us the opportunity to reiterate these points.

OCT-guided Nd:YAG laser hyaloidotomy

PURPOSE: To evaluate the effectiveness and safety of OCT-guided Nd:YAG laser hyaloidotomy as a treatment modality for subhyaloid premacular bleedings. DESIGN: Retrospective observational case report. METHODS: A young women with premacular bleeding was evaluated with OCT and Nd:YAG laser hyaloidotomy was subsequently done. RESULTS: OCT scans, especially the ones which were taken above the sedimented blood level, demonstrated that the bleeding was localized under the posterior hyaloid membrane. Rapid resolution of premacular bleeding and substantial visual acuity improvement were registered already three days after the Nd:YAG laser hyaloidotomy. CONCLUSION: Valsalva maculopathy often involves younger, working active patients who often need fast visual acuity recovery. Data from this case report demonstrated that OCT-guided Nd:YAG laser hyaloidotomy is a safe and effective treatment for subhyaloidal premacular bleedings.