Efficiency and Complication of 577-nm Laser Membranotomy for the Treatment of Retinal Sub-Inner Limiting Membrane Hemorrhage

Abstract

ObjectiveWe investigated the clinical efficiency and complications of treatment of retinal sub-inner limiting membrane (sub-ILM) hemorrhage by 577-nm semiconductive laser membranotomy.MethodsThe clinical features, ocular fundus photography, and SD-OCT image of patients who received 577-nm laser membranotomy for sub-ILM hemorrhage were assessed from January 2017 to April 2022 in this retrospective case-series study.ResultsA total of 19 patients (19 eyes) were treated for sub-ILM hemorrhage of the macula, in which eight were women and 11 were men. The age was 15–83 years (with an average age of 49.05 ± 19.41 years old). The right eye was affected in 12 patients, the left eye in seven patients. The follow-up period after laser treatment was from 0.5 to 9 months (with an average follow-up time of 3.25 ± 2.45 months). Treatment was not successful in one patient, and 577-nm laser membranotomy was successful in 18 patients (equaling a success rate of 94.74%). The best corrected visual acuity (BCVA) before laser treatment was from figure count to 40/200, and the BCVA after laser treatment was from 20/2000 to 20/20. Complications after laser treatment comprised macular hole (one patient), macular epi-membrane (one patient), vitreous hemorrhage without absorption (two patients), and sub-ILM cavity (12 patients).ConclusionsThe 577-nm laser is effective in treating sub-ILM hemorrhage and has a high success rate. Posttreatment complications should be monitored, and vitrectomy was needed with long-lasting vitreous hemorrhage and macular hole.

A brief review of Valsalva retinopathy

“…Optical coherence tomography imaging (Figure 2) should be used to distinguish the location of the bleeding. Fundus fluorescein angiography is useful for detecting neovascularization and other fundus abnormalities [19][20][21]. B-scan ultrasonography should be performed in cases of breakthrough intravitreal hemorrhage [22].…”

“…Nd:YAG (pulse/Q-switched/frequency-doubled) krypton laser membranotomy can be used for a large subhyaloid/sub-ILM hemorrhage that is located at the macula and is at least 3 disc diameters in size [5,20,31,32]. The duration of bleeding should ideally be no more than 3 weeks [5,19].…”

“…However, complications are possible [34]. One should avoid large blood vessels, maintain a safe distance from the fovea, and perform membranotomy at the inferior margin of the hemorrhage [19]. Complications mainly include the formation of a macular epiretinal membrane [35], a macular hole [36], and vitreous hemorrhage [19].…”

“…One should avoid large blood vessels, maintain a safe distance from the fovea, and perform membranotomy at the inferior margin of the hemorrhage [19]. Complications mainly include the formation of a macular epiretinal membrane [35], a macular hole [36], and vitreous hemorrhage [19]. It is noteworthy that in some cases of ILM membranotomy, the ILM may remain unsealed and not properly attach to the inner retina [37].…”

Sub-internal Limiting Membrane Hemorrhage Caused by Heavy Physical Activity

“…Spontaneous resorption of the blood entrapped in the sub-ILM space tends to be slow and may result in irreversible retinal damage and long-standing visual impairment. 6,7 In this case report, we present the case of a patient with a sub-internal limiting membrane (sub-ILM) haemorrhage due to intense physical…”