Nd:YAG laser therapy for non-resolving premacular subhyaloid hemorrhage in Saudi patients

Abstract

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.

Differentiation of premacular hemorrhages with niveau formation

“…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.…”

“…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.…”

“…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.…”

Inverse drainage Nd:YAG membranotomy for pre-macular hemorrhage

“…It presents as a circumscribed, boat-shaped, collection of blood located beneath the internal limiting membrane (ILM) and/ or between the ILM and the posterior hyaloid face. 1–11…”

Laser surgery in the management of patients with retinal vein occlusion

“…При персистенции геморрагии более двух недель также развиваются необратимые повреждения внутренних слоев сетчатки, которые требуют активной лечебной тактики, в частности витрэктомического вмешательства. В ряде случаев, учитывая все возможные риски, возможно осуществить Nd:YAG лазерную заднюю гиалоидотомию для дренирования крови в стекловидное тело с целью уменьшения токсического влияния на сетчатку и быстрого улучшения остроты зрения [13].…”