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CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 2  |  Page : 82-84

Nd:YAG laser hyaloidotomy as treatment for premacular subhyaloid hemorrhage


Department of Vitreoretinal, Drashti Netralaya, Dahod, Gujarat, India

Date of Web Publication10-Jan-2014

Correspondence Address:
Mehul A Shah
Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod - 389 151, Gujarat
India
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DOI: 10.4103/1858-540X.124837

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  Abstract 

Patients with premacular subhyaloid hemorrhage presented with sudden loss of vision. [1] Nd:YAG laser creates posterior hyaloidotomy, enabling rapid diffusion of subhyaloid hemorrhage into the vitreous gel. This case study was performed to assess the results of Nd:YAG laser hyaloidotomy. A 40-year-old diabetic male presented with painless, sudden diminution of vision in the right eye. His visual acuity (VA) for distance in Right Eye (OD) was finger counting (FC) at 1 m. Anterior segment examination was normal except for posterior cortical cataract. Oncyclopegic examination revealed premacular subhyaloid hemorrhage with fluid level. A Nd:YAG laser posterior hyaloidotomy was performed, and it allowed clear visualization of the posterior pole with improvement of visual acuity to 6/9 at 1-week follow-up. Nd:YAG laser hyaloidotomy an is effective procedure for the treatment of recent premacular subhyaloid hemorrhage, producing rapid dispersion of blood with restoration of visual function.

Keywords: Diabetic retinopathy, fluid level, posterior hyaloidotomy, subhyaloid hemorrhage


How to cite this article:
Shah MA, Shah SM, Agrawal P. Nd:YAG laser hyaloidotomy as treatment for premacular subhyaloid hemorrhage. Sudanese J Ophthalmol 2013;5:82-4

How to cite this URL:
Shah MA, Shah SM, Agrawal P. Nd:YAG laser hyaloidotomy as treatment for premacular subhyaloid hemorrhage. Sudanese J Ophthalmol [serial online] 2013 [cited 2021 Apr 19];5:82-4. Available from: https://www.sjopthal.net/text.asp?2013/5/2/82/124837


  Introduction Top


Subhyaloid hemorrhage is defined as a localized detachment of vitreous from the retina caused by the accumulation of blood, which can lead to sudden and severe loss of vision when it takes place in the macular area. The treatment ranges from conservative to posterior vitrectomy, depending on the cause, age and the status of the other eye. [1] Although spontaneous resolution is expected in most cases, it occurs in a slow, frustrating and sometimes incapacitating manner to the patient, especially in bilateral cases or in one-eyed patients. [2] A case study was performed with the aim to assess the benefit of pulsed Nd:YAG laser posterior hyaloidotomy in patients with premacular subhyaloid hemorrhage.


  Case Report Top


A 40-year-old male presented with painless, sudden diminution of vision in the right eye. His BCVA for distance in OD was FC at 1 m and N/36 for near. He had diabetes mellitus since 1 year and was on insulin. Random blood sugar was 386 mg/dL. Anterior segment examination was performed according to standard protocol, which revealed normal anterior segment and normal intraocular pressure of 17 mmHg with posterior cortical cataract. On cycloplegic examination with an indirect ophthalmoscope and +78 D biomicroscopic examination, a boat-shaped premacular subhyaloid hemorrhage with fluid level was identified [Figure 1]. A Nd:YAG laser posterior hyaloidotomy was performed using three mirror Goldman contact lenses and fluid blood trickled with gravity. The patient was examined during subsequent visits and this was documented. The laser procedure allowed clear visualization of the posterior pole with improvement of visual acuity to 6/9 at 1-week follow-up [Figure 2].
Figure 1: Fundus photograph on presentation

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Figure 2: Fundus photograph on final visit

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  Discussion Top


Premacular subhyaloid hemorrhage may occur from various vascular or hematological disorders, which include anemic retinopathy, proliferative diabetic retinopathy, blunt trauma, branch retinal vein occlusion, Valsalva retinopathy, retinal macroaneurysm rupture, Terson syndrome, age-related macular degeneration, etc. Premacular subhyaloid hemorrhage has also been reported in shaken, battered baby syndrome [3] and in acute childhood leukemia. [4] Sudden, painless and profound loss of vision is the most common presentation. [5],[6] Spontaneous resorption of blood entrapped in the subhyaloid space tends to be very slow and may take several months to years to resolve. In long-standing cases, complications like formation of an epiretinal membrane, macular traction, retinal detachment, cataract, amblyopia and toxic effect of long-standing hemorrhage may cause irreversible retinal damage and result in permanent visual loss. Observation and vitrectomy are the two old modes of treatment. Intravitreal tPA with an expansive gas is an alternative method to observation or vitrectomy for resolution of preretinal hemorrhages, which has been performed in battered babies, and may allow faster resolution of hemorrhages without the complications of vitrectomy. [3] Alternative newer methods are hyaloidotomy or membranectomy using different lasers like Nd:YAG laser (1064 nm) or Argon laser (514 nm). [7],[8],[9] However, because the hemorrhage may cause permanent macular changes before it resolves, Nd:YAG laser posterior hyaloidotomy may be indicated in selected cases. [7] Nd:YAG laser can produce a defect in the posterior hyaloid/internal limiting membrane, [8] allowing rapid diffusion of hemorrhage into the vitreous gel thus clearing the visual axis and allowing faster absorption of blood. [10] A study has been reported in which it is proved that Nd:YAG laser treatment for Valsalva retinopathy is an effective, noninvasive and safe procedure for patients with a premacular subhyaloid hemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration. [11] It also allowed rapid restoration of visualization of the macular region with expedited access for fluorescein angiography and macular photocoagulation. It is important to identify the horizontal fluid level line so that performing laser hyaloidotomy allows blood to trickle into the vitreous cavity. Nevertheless, it should be used carefully with the lowest effective energy settings to avoid collateral damage to the retina.


  Conclusion Top


Nd:YAG laser hyaloidotomy is an effective procedure for the treatment of recent premacular subhyaloid hemorrhage, producing rapid dispersion of blood with restoration of visual function without a more invasive vitreoretinal procedure.

 
  References Top

1.Buliga S, Toma C, Taina A, Beraru V, Benone C. Diabetic retrohialoidianhemorrage--invasive minimal treatment. Oftalmologia 2011;55:82-5.  Back to cited text no. 1
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2.Gass JD. Stereoscopic Atlas of macular Diseases: Diagnosis and Treatment, 3 rd ed. St. Louis. MO: C.V. Mosby; 1987. p. 560-4.   Back to cited text no. 2
    
3.Conway MD, Peyman GA, Recasens MA. Intravitreal tPA and SF6 promote clearing of premacular subhyaloid hemorrhages in shaken and battered baby syndrome. Ophthalmic Surg Lasers 1999;30:435-41.  Back to cited text no. 3
    
4.Khadka D, Sharma AK, Shrestha JK, Pant B, Pant S, Shrestha A. "Nd: Yag laser treatment for sub-hyaloid hemorrhage in childhood acute leukemia." Nepal J Ophthalmol 2012;4:102-7.  Back to cited text no. 4
    
5.Kuhn F, Morris R, Witherspoon CD, Mester V. Terson Syndrome: Results of vitrectomy and the significance of vitreous haemorrhage in patients with subarachnoid haemorrhage. Ophthalmology 1998;105:472-7.   Back to cited text no. 5
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6.Postel EA, Mieler WF. Posterior segment manifestations of blunt trauma. In: Guyer DR, Yannuzzi LA, Chang S, editors. M, Jk. Retina-vitreous-macula. Vol. 1. Philadelphia: WB Saunders; 1999. p. 831-43.  Back to cited text no. 6
    
7.Celebi S Kukner AS. Photodisruptive Nd: YAG laser in the management of premacular subhyaloid hemorrhage. Eur J Ophthalmol 2001;11:281-6.  Back to cited text no. 7
    
8.Raymond LA. Neodymium: YAG Laser treatment for hemorrhages under the internal limiting membrane and posterior hyaloid face at the macula. Ophthalmology 1995;102:406-11.  Back to cited text no. 8
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9.Ulbig MW, Mangouritsas G, Rothbacher HH, Hamilton AM, McHugh JD. Long- term results after drainage of premacular subhyaloid haemorrhage into the vitreous with a pulsed Nd: YAG laser. Arch Ophthalmol 1998;116:1465-9.   Back to cited text no. 9
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10.Rennie CA, Newman DK, Snead MP, Flanagan DW."Nd: YAG laser treatment for premacular subhyaloid haemorrhage." Eye (Lond) 2001;15:519-24.  Back to cited text no. 10
    
11.Durukan AH, Kerimoglu H, Erdurman C, Demirel A, Karagul S. Long-term results of Nd: YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy. Eye (Lond) 2008;22:214-8.  Back to cited text no. 11
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