Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy

Kuruvilla, Oscar; Munie, Metasebia; Shah, Manthan; Desai, Uday R.; Miller, J. A.; Ober, Michael D.

doi:10.1016/j.sjopt.2014.02.006

Cited by 30 publications

(45 citation statements)

References 30 publications

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“…In the studies those achieved successful drainage of premacular hemorrhage, visual acuity improved within days in most of the patients, the degree of improvement depended on the underlying and pre-existing macular damage [ 9 , 15 , 17 , 18 ]. As in the previous studies [ 10 , 11 , 22 , 23 ], valsalva retinopathy and Terson’s syndrome in this series showed the best results owing to the lack of underlying pathology. Additionally, in this study, a patient with high altitude retinopathy showed good improvement in visual acuity and we had also observed premacular subhyaloid hemorrhage in 2 more patients who had a history of ascension to high altitude.…”

Section: Discussionsupporting

confidence: 83%

“…This signifies that the state of blood in the premacular area is important rather than the duration of symptoms. In this study, we did not compare the success of Nd:YAG laser hyaloidotomy with the duration of symptoms as in other series [ 7 , 8 , 10 , 12 , 15 , 22 , 23 ]. In this series hyaloidotomy was successful in 19 eyes(86.4 %) with visual improvement in all successful cases, though a patient with Eales’ disease after drainage of premacular hemorrhage developed tractional retinal detachment at macula at 6 weeks follow up requiring a pars plana vitrectomy with recovery to 6/6.…”

Section: Discussionmentioning

confidence: 96%

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Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 96%

Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage

et al. 2016

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“…Haemorrhages less than this size may not provide adequate cushion effect and this could lead to inadvertent retinal damage by the photodisruptive laser 6. If possible, always drain from a region distant enough from the fovea along the inferior border where there is significant haemorrhagic elevation 7. Khadka et al 1 have recently reported an 86% success rate of Nd-YAG laser in management of premacular SHH in a study on 21 eyes with no complications at 6 months follow-up.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic parafoveal macular hole following Nd-YAG posterior hyaloidotomy for premacular haemorrhage

Bypareddy

Chawla²,

Azad

et al. 2016

BMJ Case Reports

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Premacular sub-internal limiting membrane (sub-ILM) haemorrhage is a known cause of sudden profound loss of vision. Neodymium-doped yttrium aluminium garnet (ND-YAG) posterior hyaloidotomy is an inexpensive, effective and safe treatment modality for rapid drainage of haemorrhage covering the macula. An 18-year-old male patient presented to us with a history of Nd-YAG posterior hyaloidotomy for Valsalva-related premacular bleed. At the posterior pole, a cavity formed by the detached ILM with a central defect in ILM-posterior hyaloid complex was evident. High-definition optical coherence tomography (HD-OCT) showed normal foveal contour with a parafoveal macular hole. Hence, good clinical judgement, appropriate positioning of hyaloidotomy and use of lowest possible energy level is the key to a successful and safe laser drainage of a premacular haemorrhage.

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“…To our knowledge, the current case is the only report of etoposide and ifosfamide associated with anemia and thrombocytopenia resulting in spontaneous sub-ILM hemorrhage. As in the previously cited cases, we considered treatment with vitrectomy versus Nd:YAG membranotomy [ 15 ]. Delaying intervention runs the risk of scar formation in the pocket of hemorrhage and secondary vision loss.…”

Section: Discussionmentioning

confidence: 99%

Valsalva-Like Retinopathy Secondary to Pancytopenia following Induction of Etoposide and Ifosfamide

Prinzi

Saraf

Desai

et al. 2015

Case Reports in Ophthalmological Medicine

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Etoposide and ifosfamide are chemotherapeutic agents used frequently in the treatment of sarcomas and hematologic malignancies. Ocular side effects are rarely reported. We describe a case of a patient on etoposide and ifosfamide who presented with unilateral vision loss, anemia, and thrombocytopenia. The patient was found to have a large subinternal limiting membrane hemorrhage in the right eye that is thought to be related to his anemia and thrombocytopenia. The hemorrhage resolved spontaneously after 10 days. This case illustrates how bone marrow suppression by chemotherapeutic agents may indirectly contribute to retinal hemorrhages resulting in at least transient vision loss.

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Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy

Abstract: Nd:YAG membranotomy is a non-invasive, office-based treatment option that may be successfully used to treat premacular hemorrhage secondary to valsalva retinopathy.

Cited by 30 publications

References 30 publications

Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage

Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage

Iatrogenic parafoveal macular hole following Nd-YAG posterior hyaloidotomy for premacular haemorrhage

Valsalva-Like Retinopathy Secondary to Pancytopenia following Induction of Etoposide and Ifosfamide

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