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. 2014 Apr;28(2):145-51.
doi: 10.1016/j.sjopt.2014.02.006. Epub 2014 Feb 28.

Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy

Oscar Kuruvilla  1 , Metasebia Munie  1 , Manthan Shah  1 , Uday Desai  1 , Joel A Miller  2 , Michael D Ober  3
Affiliations

Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy

Oscar Kuruvilla et al. Saudi J Ophthalmol. 2014 Apr.

Abstract

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.

Keywords: Premacular hemorrhage; Valsalva retinopathy; YAG membranotomy.

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Figures

Figure 1
Figure 1
(A) Montage color fundus photograph from case 1 demonstrating a boat-shaped premacular hemorrhage due to valsalva retinopathy. (B) Color montage following Neodymium:YAG (Nd:YAG) hyaloidotomy, the hemorrhage drains inferiorly into vitreous.
Figure 2
Figure 2
(A) Color fundus photograph three years after successful Nd:YAG hyaloidotomy of the patient in Case 1, there is wrinkling of posterior hyaloid. (B) Corresponding vertical optical coherence tomography scan shows the detached internal limiting membrane (attached to posterior hyaloid) with an opening secondary to Nd:YAG membranotomy without underlying retinal damage.
Figure 3
Figure 3
(A) Color fundus montage photograph of case 2 showing premacular hemorrhage and a larger area of subretinal hemorrhage along superotemporal arcade. (B) Color fundus montage immediately following Nd:YAG membranotomy with active drainage of blood. (C) Three days later, color fundus photograph shows that the fovea is uncovered and the subretinal blood appears stable. (D) Corresponding vertical OCT shows shadow effect of the preretinal hemorrhage obstructing the image of the underlying retina and subretinal space.
Figure 4
Figure 4
(A) Color fundus photograph of case 3 showing a well-circumscribed premacular hemorrhage with intraretinal hemorrhages along the superotemporal arcade and along the peripheral border of the pre-retinal blood. (B) Color fundus photograph 3 weeks later demonstrating the blood dehemoglobinized and clotted. (C and D) Color fundus photograph immediately after Nd:YAG membranotomy shows blood flowing through membranotomy site, but drainage was minimal due to coagulation.
Figure 5
Figure 5
(A) Montage color photograph of case 4 demonstrating dense premacular hemorrhage. (B) Color montage photograph shows successful Nd:YAG membranotomy performed 6 weeks following initial presentation. (C) Color fundus photograph 4 months after Nd:YAG membranotomy shows complete resolution of hemorrhage with early wrinkling of the ILM.
None
See this image and copyright information in PMC

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