Nd:YAG laser membranotomy treatment of premacular hemorrhage in two children with hematologic disease

PURPOSE: Nd:YAG laser membranotomy is considered a safe treatment of premacular hemorrhage (PMH) in adult patients, enabling rapid enhancement of visual functions. For children, however, pars plana vitrectomy (PPV) performed under general anesthesia has been the accepted treatment. In this report, the authors describe Nd:YAG laser membranotomy (LM) in two children with PMH complicated by hematologic disease. METHODS: Size of lesions was measured in optic disc diameters (DD). The authors performed three openings in the anterior surface of PMH with immediate intravitreal drainage of blood in both patients. RESULTS: Rapid enhancement of visual functions was followed. The authors observed no complications in 1 year of follow-up. CONCLUSIONS: LM may be a safe method of treatment of PMH in children in selected cases.     

Krypton laser membranotomy for premacular hemorrhage

BACKGROUND: To evaluate the safety and effectiveness of krypton laser membranotomy. METHODS: Eleven patients (12 eyes) with premacular hemorrhage were enrolled from April 1998 to November 2002. The causes of premacular hemorrhage were proliferative diabetic retinopathy (7 patients, 8 eyes), Valsalva retinopathy (3 patients) and leukemia (1 eye). Krypton laser was used to create a membranotomy on the sloping edge of the premacular hemorrhage. Five eyes with proliferative diabetic retinopathy were treated with inferior panretinal photocoagulation and laser membranotomy simultaneously. After intravitreal dispersion of premacular blood, fundus examinations were performed in all eyes and fluorescein angiography in 5 patients to evaluate the retinal damage. RESULTS: Vision was improved within 2 weeks after surgery in all eyes with premacular hemorrhage, which received krypton laser membranotomy. No retinal damage was seen at the site of membranotomy. No eye needed vitrectomy postoperatively during the follow-up (mean, 17 months). CONCLUSION: Krypton laser membranotomy appears to be a safe and simple alternative procedure for treating selected cases of premacular hemorrhage. Further trials are necessary to evaluate its benefit.     

Nd:YAG laser treatment for Valsalva premacular hemorrhage

OBJECTIVE:To report a case of Valsalva premacular hemorrhage treated by Nd:YAG laser.;METHODS:A patient who presented with Valsalva premacular hemorrhage was treated with photodisruptive Nd:YAG laser to drain the entrapped premacular blood into the vitreous.;RESULTS:After photodisruption, vision in the affected eye improved rapidly due to exposure of the macula.;CONCLUSIONS:Nd:YAG laser treatment may be a good alternative for recent preretinal hemorrhages. Clinical benefits include rapid visual rehabilitation and the avoidance of vitrectomy.     

Nd:YAG laser therapy for non-resolving premacular subhyaloid hemorrhage in Saudi patients

Purpose

To report anatomical and visual outcomes of Nd:YAG laser posterior hyaloidotomy (NYPH) in Saudi patients affected by Premacular subhyaloid haemorrhage (PMSHH).

The effect of Nd:YAG laser membranotomy and intravitreal tissue plasminogen activator with gas on massive diabetic premacular hemorrhage.

BACKGROUND AND OBJECTIVE: To investigate the combined therapeutic effects of Nd:YAG laser membranotomy and intravitreal tissue plasminogen activator (tPA) (Actilyse; Boehringer Ingelheim, Ingelheim, Germany) injection with perfluoropropane (C3F8, 100%) injection on massive diabetic premacular hemorrhage. PATIENTS AND METHODS: Nd:YAG laser membranotomy was performed on the hemorrhagic membrane of premacular hemorrhage, and tPA (25 microg/0.1 mL) was injected into the vitreous cavity of seven eyes with massive diabetic premacular hemorrhage. For each procedure 0.2 mL of C3F8 was also injected. RESULTS: After the combined therapy, the patients recovered vision within 4 weeks and the hemorrhages were completely absorbed within 8 weeks. Visual acuity at the last follow-up visit improved to a mean of 10 logarithm of the minimum angle of resolution lines in all cases. There were no associated ophthalmic complications. CONCLUSION: The combined therapy resulted in resolution of premacular hemorrhages with proliferative diabetic retinopathy and may allow for faster resolution of premacular hemorrhages and lessen the need for vitrectomy.     

Krypton laser membranotomy in the treatment of dense premacular hemorrhage

BACKGROUND: Neodymium:YAG (Nd:YAG) laser and argon laser membranotomy have been used in patients with premacular hemorrhage to drain premacular blood into the vitreous cavity and rapidly clear the hemorrhage. However, the Nd:YAG laser appears to be difficult to use, and argon laser energy may be more likely to be absorbed by the ocular media. We performed a study to evaluate the safety and effectiveness of krypton laser membranotomy in selected cases of premacular hemorrhage. METHODS: Sixteen patients (17 eyes) with dense premacular hemorrhage for 2 weeks or less were enrolled from April 1998 to February 2004. The causes of premacular hemorrhage were proliferative diabetic retinopathy (PDR) in 12 eyes, Valsalva retinopathy in 3 eyes, leukemia in I eye and retinal arterial macroaneurysm in I eye. Krypton laser was used to create a membranotomy on the sloping edge of the premacular hemorrhage. Five eyes with PDR were treated with inferior panretinal photocoagulation and laser membranotomy simultaneously. After intravitreal dispersion of premacular blood, fundus examination was performed in all eyes and fluorescein angiography in five eyes to evaluate retinal damage. RESULTS: All eyes had visual improvement within 2 weeks postoperatively. No retinal damage was seen at the site of membranotomy in any eye. No eye needed vitrectomy postoperatively during a mean follow-up duration of 18.6 months. INTERPRETATION: Krypton laser membranotomy appears to be a safe and simple alternative procedure for treating selected cases of premacular hemorrhage. Further trials are necessary to evaluate its benefit.     

Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy

Purpose

To report four cases of premacular hemorrhage secondary to valsalva retinopathy treated with Nd:YAG membranotomy and discuss techniques as well as the literature.

Design

Retrospective case series.

Methods

A retrospective review was conducted for four patients with vision obstructing hemorrhage secondary to valsalva retinopathy. These patients were all treated with Nd:YAG membranotomy.

Results

Four patients with premacular hemorrhage secondary to valsalva retinopathy were treated with Nd:YAG laser creating a membranotomy to drain the hemorrhage. Power settings ranged from 1.7 to 3.8 mJ. Visual acuity at presentation ranged from 20/400 (1 patient) to count fingers (3 patients). Visual acuity improved in three out of four patients after laser treatment. Final visual acuity ranged from 20/20 to 20/30 in these three patients. One patient was lost to follow up after performing laser membranotomy and therefore visual acuity after treatment was not obtained. No complications were noted.

Conclusion

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

Photodisruptive Nd:YAG laser in the management of premacular subhyaloid hemorrhage.

PURPOSE: Premacular subhyaloid hemorrhage is usually a benign condition that generally improves spontaneously and rarely causes visual loss. However, because the hemorrhage may cause permanent macular changes before it resolves, Nd:YAG laser posterior hyaloidotomy may be indicated in selected cases. This study investigated the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser treatment. METHODS: This study was conducted between February 1996 and March 1999. Six patients had a circumscribed premacular hemorrhage in one eye and were treated with the Nd:YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from Valsalva retinopathy (2 cases), proliferative diabetic retinopathy (2 cases), central retinal vein occlusion (1 case), and blunt ocular trauma (1 case). The size of the hemorrhage is expressed in disc diameters. RESULTS: The mean pretreatment hemorrhage measured 5.7 disc diameters (range 3.5-8.0). Visual acuity in all cases before laser treatment was hand movement. After laser treatment, the hemorrhage instantly drained into the vitreous cavity, resulting in rapid improvement of vision. Drainage was complete within one week and visual acuity improved dramatically. The mean follow-up was 26.3 months (range 7-42 months). No retinal damage or rebleeding occurred due to the laser treatment, and vitrectomy was not required in any eye. CONCLUSIONS: Nd:YAG laser posterior hyaloidotomy may be useful for draining a premacular hemorrhage into the vitreous cavity in selected cases. To establish this as a routine procedure, a randomized prospective study is needed to compare observation, primary vitrectomy, and Nd:YAG laser treatment.     

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

AIMS: Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy. METHODS: Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months. RESULTS: All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage. CONCLUSION: Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.     

Epiretinal membrane formation with internal limiting membrane wrinkling after Nd:YAG laser membranotomy in valsalva retinopathy

PURPOSE: 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. DESIGN: Interventional case report. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.