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      Evaluation of pulsed Nd:YAG laser posterior hyaloidotomy as an emergency treatment for blinding premacular subhyaloid hemorrhage

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          Abstract

          Purpose:

          This study aimed to evaluate the benefits of Nd:YAG laser posterior hyaloidotomy as a method allowing rapid drainage of subhyaloid hemorrhage into the vitreous gel.

          Design:

          Nonrandomized, prospective, interventional, controlled case series.

          Methods:

          Nd:YAG laser posterior hyaloidotomy was performed in four eyes of three patients with premacular subhyaloid hemorrhage. The etiologies were bleeding tendency, proliferative diabetic retinopathy, and idiopathic. Four eyes of four patients with premacular subhyaloid hemorrhage were managed conservatively. The etiologies were proliferative diabetic retinopathy and Valsalva retinopathy.

          Results:

          A rapid resolution of subhyaloid hemorrhage with improvement of visual acuity was achieved in all patients treated with Nd:YAG laser posterior hyaloidotomy, without evidence of damage to the retina or choroid. With regard to the conservatively managed eyes, there was a tendency towards slow spontaneous absorption of hemorrhage during the follow-up period.

          Conclusion:

          Nd:YAG laser posterior hyaloidotomy was a safe and effective procedure for rapid resolution of premacular subhyaloid hemorrhage, allowing rapid restoration of visual acuity, visualization of the underlying retina, expedited access for macular photocoagulation and avoidance of vitrectomy.

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          Most cited references8

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          Long-term results after drainage of premacular subhyaloid hemorrhage into the vitreous with a pulsed Nd:YAG laser.

          Tracey Hamilton, H Rothbacher, Thomas McHugh … (1998)
          To investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser in a large series of patients with long-term follow-up. A retrospective review was conducted on 21 eyes with a circumscribed premacular subhyaloid hemorrhage of various causes. These eyes were treated with a pulsed Nd:YAG laser to drain the entrapped blood into the vitreous. The period of review ranged from 12 to 32 months (mean, 22 months). In 16 eyes, visual acuity improved within 1 month. Four eyes had persistent, dense, nonclearing vitreous opacity for at least 3 months and finally required vitrectomy. One clotted hemorrhage did not drain into the vitreous. Final visual outcome was determined by the underlying diagnosis, such as Valsalva retinopathy (7 eyes), diabetic retinopathy (7 eyes), branch retinal vein occlusion (4 eyes), and retinal macroaneurysm, Terson syndrome, or blood dyscrasia (1 eye each). Eyes with Valsalva retinopathy fared the best. Complications included a macular hole in 1 eye and a retinal detachment from a retinal break in a myopic patient. Drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser is a viable treatment alternative for eyes with recent bleeding. However, a macular hole and a retinal detachment were observed as complications. Thus, to establish Nd:YAG laser treatment as a routine procedure, the risks and benefits have to be weighed in a randomized trial and compared with those of deferral of treatment or primary vitrectomy.
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            Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5.

            (1990)
            Six hundred sixteen eyes with recent severe diabetic vitreous hemorrhage reducing visual acuity to 5/200 or less for at least 1 month were randomly assigned to either early vitrectomy or deferral of vitrectomy for 1 year. The proportion of eyes with visual acuity of 10/20 or better was higher in the early vitrectomy group than in the deferral group throughout the 4-year follow-up period. Up to the 18-month visit, the early group had a higher proportion of eyes with visual acuity of no light perception. An increased chance of obtaining good vision with early vitrectomy was clearly present in the type I diabetes group, particularly in patients who developed severe vitreous hemorrhage after less than 20 years of diabetes, a patient group tending to have more severe proliferative retinopathy. This advantage was not found in the type II diabetes group, in which patients were older and tended to have less severe retinopathy. The findings of this and previous Diabetic Retinopathy Vitrectomy Study reports support early vitrectomy in eyes known or suspected to have very severe proliferative diabetic retinopathy as a means of increasing the chance of restoring or maintaining good vision.
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              Epiretinal membrane formation with internal limiting membrane wrinkling after Nd:YAG laser membranotomy in valsalva retinopathy.

              Anthony Chan, Alvin Kwok, Justine Y Q Lai (2003)
              To report the location of premacular hemorrhage in Valsalva retinopathy and epiretinal membrane formation with internal limiting membrane (ILM) wrinkling after neodymium;yttrium-aluminum-garnet (Nd:YAG) laser membranotomy. Interventional case report. A 35-year-old man with a massive premacular hemorrhage due to Valsalva retinopathy underwent Nd:YAG laser membranotomy. After membranotomy, his visual acuity improved from 20/200 to 20/25. Ten months later, he developed metamorphopsia with visual acuity of 20/30. A semiopacified membrane with radiating striae was found, and pars plana vitrectomy was performed for membrane removal. Histologic examination of the membrane showed hemosiderin deposits within macrophages on the retinal side of the ILM. One year later, the patient was asymptomatic with visual acuity of 20/20. To our knowledge, histopathologic confirmation of the sub-ILM hemorrhage in Valsalva retinopathy and epiretinal membrane formation with ILM wrinkling as a complication after Nd:YAG laser membranotomy have not been previously reported.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Access Emerg Med
                Journal ID (iso-abbrev): Open Access Emerg Med
                Title: Open Access Emergency Medicine : OAEM
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-1500
                Publication date Collection: 2011
                Publication date (Electronic): 13 May 2011
                Volume: 3
                Pages: 33-37
                Affiliations
                [1 ]Department of Ophthalmology, Assiut University Hospital, Assiut, Egypt;
                [2 ]Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
                Author notes
                Correspondence: Tarek A Shazly, 20 Pondmeadow Dr Ste 203, Reading, MA 01867, USA, Tel +1 781 315 3814, Fax +1 781 942 9877, Email shazlyt@ 123456gmail.com
                Article
                Publisher ID: oaem-3-033
                DOI: 10.2147/OAEM.S19235
                PMC ID: 4753965
                PubMed ID: 27147850
                SO-VID: 458bb27a-06ac-40c4-a18c-56c8fd0a1880
                Copyright © © 2011 Hazem and Shazly, publisher and licensee Dove Medical Press Ltd
                License:

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Date received : 12 May 2011
                Categories
                Subject: Original Research

                Keywords: retinal hemorrhage,vitreous hemorrhage,laser surgery,proliferative diabetic retinopathy
                Data availability:
                Keywords: retinal hemorrhage, vitreous hemorrhage, laser surgery, proliferative diabetic retinopathy

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