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

Khadka D, Bhandari S, Bajimaya S, Thapa R, Paudyal G, Pradhan E - BMC Ophthalmol (2016)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Geta Eye Hospital, Dhangadi, Nepal.

ABSTRACT

Background: Premacular 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.

Methods: Patients 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.

Results: There 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.

Conclusion: Nd: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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Related in: MedlinePlus

Color fundus photographs of a patient with CNVM. a Characteristic boat shaped hemorrhage. b Immediately after Nd Yag laser. c 3 months later after couple of intravitreal Bevacizumab injection
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Fig6: Color fundus photographs of a patient with CNVM. a Characteristic boat shaped hemorrhage. b Immediately after Nd Yag laser. c 3 months later after couple of intravitreal Bevacizumab injection

Mentions: This study included twenty-two eyes of nineteen patients with premacular subhyaloid hemorrhage, 17 (89.48 %) were male and 2 (10.52 %) were female. In three patients premacular subhyaloid hemorrhage was bilateral. Mean age of the participants was 41.68 ± 17.08 years (range 18–76 years) with a mean duration of symptoms 15.04 days (range 1–49 days). Etiologies of premacular subhyaloid hemorrhage in 22 eyes were noted as valsalva retinopathy in 5 (22.72 %) [Fig. 1], ruptured retinal artery macroaneurysm in 2 (9.09 %) [Fig. 2], Eales’ disease in 5 (22.72 %) [Fig. 3a], Terson’s syndrome in 1 (4.54 %), proliferative diabetic retinopathy (PDR) in 4 (18.18 %), leukemic retinopathy in 2 (9.09 %) [Fig. 4], high altitude retinopathy in 1 (4.54 %) [Fig. 5], choroidal neovascular membrane (CNVM) in 1 (4.54 %) [Fig. 6] and branch retinal vein occlusion in 1 (4.54 %). The mean pretreatment hemorrhage as judged by fundus photography was 6.27 disc areas. Most of the cases of Valsalva retinopathy showed sub-ILM bleed [Fig. 7a] and one with true subhyaloid hemorrhage. One patient with Eales’ disease had both sub-ILM and subhyaloid component. Fundus fluorescence angiography was carried out in few patients for diagnostic purpose and for monitoring of therapeutic responses [Fig. 3e & f].Fig. 1


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

Khadka D, Bhandari S, Bajimaya S, Thapa R, Paudyal G, Pradhan E - BMC Ophthalmol (2016)

Color fundus photographs of a patient with CNVM. a Characteristic boat shaped hemorrhage. b Immediately after Nd Yag laser. c 3 months later after couple of intravitreal Bevacizumab injection
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835902&req=5

Fig6: Color fundus photographs of a patient with CNVM. a Characteristic boat shaped hemorrhage. b Immediately after Nd Yag laser. c 3 months later after couple of intravitreal Bevacizumab injection
Mentions: This study included twenty-two eyes of nineteen patients with premacular subhyaloid hemorrhage, 17 (89.48 %) were male and 2 (10.52 %) were female. In three patients premacular subhyaloid hemorrhage was bilateral. Mean age of the participants was 41.68 ± 17.08 years (range 18–76 years) with a mean duration of symptoms 15.04 days (range 1–49 days). Etiologies of premacular subhyaloid hemorrhage in 22 eyes were noted as valsalva retinopathy in 5 (22.72 %) [Fig. 1], ruptured retinal artery macroaneurysm in 2 (9.09 %) [Fig. 2], Eales’ disease in 5 (22.72 %) [Fig. 3a], Terson’s syndrome in 1 (4.54 %), proliferative diabetic retinopathy (PDR) in 4 (18.18 %), leukemic retinopathy in 2 (9.09 %) [Fig. 4], high altitude retinopathy in 1 (4.54 %) [Fig. 5], choroidal neovascular membrane (CNVM) in 1 (4.54 %) [Fig. 6] and branch retinal vein occlusion in 1 (4.54 %). The mean pretreatment hemorrhage as judged by fundus photography was 6.27 disc areas. Most of the cases of Valsalva retinopathy showed sub-ILM bleed [Fig. 7a] and one with true subhyaloid hemorrhage. One patient with Eales’ disease had both sub-ILM and subhyaloid component. Fundus fluorescence angiography was carried out in few patients for diagnostic purpose and for monitoring of therapeutic responses [Fig. 3e & f].Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Geta Eye Hospital, Dhangadi, Nepal.

ABSTRACT

Background: Premacular 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.

Methods: Patients 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.

Results: There 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.

Conclusion: Nd: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.

Show MeSH
Related in: MedlinePlus