Hyaloidotomy for Subhyaloidal Hemorrhage: OCT Findings of two Different Treatment Modalities

Introduction

Premacular subhyaloidal hemorrhage typically causes acute profound visual deterioration. Common causes for a subhyaloidal hemorrhage are retinal arterial macroaneurysms, arterial hypertension, diabetic retinopathy, hematological disorders and ocular trauma [1], [2], [3], [4]. In healthy adults it can be caused by a Valsalva maneuver leading to spontaneous rupture of superficial retinal capillaries [5]. Using spectral-domain optical coherence tomography (SD-OCT) the anatomical location of the hemorrhage can be exactly determined.

Controversy still exists about the best time for treatment and the specific treatment modality [6], [7]. Nd:YAG-laser-hyaloidotomy has been suggested in recent years to facilitate blood drainage and restoring vision faster [8], [9]. Thanks to the introduction of SD-OCT we are now able to precisely image the site of laser impact and to compare different lasers used for hyaloidotomy. We describe a case where both diode- and Nd:YAG-laser treatment have been consecutively applied with only the latter being successful at drainage and showing a visible effect on SD-OCT.

• References

• 1 Iijima H, Satoh S, Tsukahara S. Nd:YAG laser photodisruption for preretinal hemorrhage due to retinal macroaneurysm. Retina 1998; 18: 430-434
• 2 OʼHanley GP, Canny CL. Diabetic dense premacular hemorrhage. A possible indication for prompt vitrectomy. Ophthalmology 1985; 92: 507-511
• 3 Khadka D, Sharma AK, Shrestha JK et al. Nd:Yag laser treatment for sub-hyaloid hemorrhage in childhood acute leukemia. Nepal J Ophthalmol 2012; 4: 102-107
• 4 Russell SR, Hageman GS. Hemorrhagic detachment of the internal limiting membrane after penetrating ocular injury. Retina 1992; 12: 346-350
• 5 Meyer CH, Mennel S, Rodrigues EB et al. Is the location of valsalva hemorrhages submembranous or subhyaloidal?. Am J Ophthalmol 2006; 141: 231 author reply 231 – 232
• 6 Venkatesh R, Manoj S, Badella S et al. Rapid resolution of premacular haemorrhage after Nd:YAG laser posterior hyaloidotomy. Acta Ophthalmol Scand 2007; 85: 216-217
• 7 Wu TT, Kung YH, Lin CS. Non-vitrectomizing vitreous surgery and adjuvant intravitreal tissue plasminogen activator for non-recent massive premacular hemorrhage. J Chin Med Assoc 2011; 74: 574-578
• 8 Abouzeid H, Wolfensberger TJ. Nd:YAG laser for treatment of premacular subhyaloid hemorrhage. Klin Monatsbl Augenheilkd 2011; 228: 389-390
• 9 Rennie CA, Newman DK, Snead MP et al. Nd:YAG laser treatment for premacular subhyaloid haemorrhage. Eye (Lond) 2001; 15: 519-524