Inverse drainage Nd:YAG membranotomy for pre-macular hemorrhage

Babu, Naresh; Kohli, Piyush; Rajan, Renu P; Ramasamy, Kim

doi:10.1177/11206721221102258

Cited by 3 publications

(6 citation statements)

References 33 publications

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“…An observation period of around one month would be appropriate. For the treatment of sub-ILM hemorrhage, observation, YAG laser and vitrectomy are used [1][2][3][4][5][6][7] . Waiting for spontaneous absorption is recommended for small hemorrhage.…”

Section: Premacular Hemorrhage With Niveau Formationmentioning

confidence: 99%

“…Premacular hemorrhage may cause sudden loss of vision when the accumulation of blood is localized in the macular region. Various causes have been reported, such as retinal arterial macroaneurysm, Valsalva retinopathy, trauma, Terson syndrome, proliferative diabetic retinopathy, retinal vein occlusion, Eales' disease, pregnancy and hematologic disorders [1][2][3][4][5][6][7] . Different treatment approaches have been used, including observation [1] , neodymium-doped yttrium aluminum garnet (Nd:YAG) laser hyaloidotomy or membranotomy [2][3][4][5] , and vitrectomy [6][7] , but no clear guidelines are available.…”

mentioning

confidence: 99%

“…Various causes have been reported, such as retinal arterial macroaneurysm, Valsalva retinopathy, trauma, Terson syndrome, proliferative diabetic retinopathy, retinal vein occlusion, Eales' disease, pregnancy and hematologic disorders [1][2][3][4][5][6][7] . Different treatment approaches have been used, including observation [1] , neodymium-doped yttrium aluminum garnet (Nd:YAG) laser hyaloidotomy or membranotomy [2][3][4][5] , and vitrectomy [6][7] , but no clear guidelines are available. One reason is that the different anatomical forms of premacular hemorrhage are not differentiated before treatment; namely, hemorrhage in the posterior precortical vitreous pocket, hemorrhage behind the ILM, and hemorrhage between the ILM and the posterior vitreous cortex.…”

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confidence: 99%

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Differentiation of premacular hemorrhages with niveau formation

Kitagawa¹,

Kawamura²,

Kaneko³

et al. 2022

Int J Ophthalmol

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W e present three anatomical forms of premacular hemorrhage with niveau formation: hemorrhage in posterior precortical vitreous pocket (intrapocket hemorrhage), sub-internal limiting membrane (ILM) hemorrhage, and premacular retrocortical hemorrhage. Niveau formation is the formation of a horizonal boundary between fluid and blood cells when they accumulate in a closed space, because blood cells with higher specific gravity settle in a standing position. Differentiating between the three forms of hemorrhage is important for understanding the pathophysiology of premacular hemorrhage and selecting treatment. Premacular hemorrhage may cause sudden loss of vision when the accumulation of blood is localized in the macular region. Various causes have been reported, such as retinal arterial macroaneurysm, Valsalva retinopathy, trauma, Terson syndrome, proliferative diabetic retinopathy, retinal vein occlusion, Eales' disease, pregnancy and hematologic disorders [1][2][3][4][5][6][7] . Different treatment approaches have been used, including observation [1] , neodymium-doped yttrium aluminum garnet (Nd:YAG) laser hyaloidotomy or membranotomy [2][3][4][5] , and vitrectomy [6][7] , but no clear guidelines are available. One reason is that the different anatomical forms of premacular hemorrhage are not differentiated before treatment; namely, hemorrhage in the posterior precortical vitreous pocket, hemorrhage behind the ILM, and hemorrhage between the ILM and the posterior vitreous cortex.

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Section: Premacular Hemorrhage With Niveau Formationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Differentiation of premacular hemorrhages with niveau formation

Kitagawa¹,

Kawamura²,

Kaneko³

et al. 2022

Int J Ophthalmol

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“…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].…”

Section: Diagnosismentioning

confidence: 99%

“…These include Nd:YAG laser membranotomy and pars plana vitrectomy [3,30]. 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].…”

Section: Treatmentmentioning

confidence: 99%

A brief review of Valsalva retinopathy

Asteris¹,

Kalogeropoulos²,

Moussa³

et al. 2022

Med Hypothesis Discov Innov Optom

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Background: Valsalva retinopathy is a specific type of retinopathy that appears following an acute rise in intrathoracic or intra-abdominal pressure. This review focuses on current literature and future directions for the diagnosis and management of Valsalva retinopathy. Methods: In this brief review, the literature was searched to provide an extensive general and updated description of Valsalva retinopathy, focusing on its management and prognosis. Selected articles are summarized to present the etiology, general pathology, pathophysiology, symptoms, signs, diagnosis, differential diagnosis, treatment, and prognosis of Valsalva retinopathy. Results: The main symptom of Valsalva retinopathy is loss of visual acuity following exertion. This is caused by the rupture of small superficial vessels in the macula and perimacular areas, leading to extravasation of blood. No link between age, sex, or race has been found, although fundus vessel abnormalities pose some predisposition to the disease. During fundoscopy, Valsalva retinopathy appears most frequently as well-defined preretinal hemorrhages confined to the sub-internal limiting membrane (ILM) or subhyaloid space. If ILM rupture occurs, hyaloid hemorrhage can appear. Diagnosis is based on the patient’s medical history and a standard examination. Usually, only observation of the patient is required, with the hemorrhage resolving within weeks to months. In cases of large premacular hemorrhage or large sub-ILM/subhyaloid hemorrhage, vitrectomy or Nd:YAG krypton laser membranotomy can be performed. Conclusions: Of all the aspects of Valsalva retinopathy that might trouble the physician, the most challenging features are differential diagnosis and the choice of optimal treatment. Therapeutic strategies for Valsalva retinopathy can be either conservative or based on Nd:YAG laser membranotomy and/or vitrectomy. All methods seem to have good outcomes. However, physicians should not be afraid of advancing beyond conservative therapy, especially in the event of persistent premacular hemorrhage, which could lead to permanent retinal damage if valuable time is lost, even after vitrectomy.

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