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Review
. 2025 Aug 22:24741264251364824.
doi: 10.1177/24741264251364824. Online ahead of print.

Outcomes of Nd:YAG Laser Posterior Membranotomy in the Treatment of Macular Preretinal Hemorrhage: A Systematic Review and Meta-Analysis

Michael Bouaziz  1 , Daniel Zhu  1 , Edward Zhu  2 , Ethan Abizadeh  3 , George Jiao  1 , Talia R Kaden  4   5
Affiliations
Review

Outcomes of Nd:YAG Laser Posterior Membranotomy in the Treatment of Macular Preretinal Hemorrhage: A Systematic Review and Meta-Analysis

Michael Bouaziz et al. J Vitreoretin Dis. .

Abstract

Purpose: To examine the success rate of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior membranotomy as a treatment option to facilitate drainage of macular preretinal hemorrhage into the vitreous cavity. Methods: A literature search was conducted using the PubMed, Embase, and Scopus databases for studies describing the use of Nd:YAG laser for a posterior membranotomy in the setting of macular preretinal hemorrhages. The main outcome of interest was drainage of the hemorrhage into the vitreous cavity without need for subsequent vitrectomy. A meta-analysis of proportions measured the pooled success rate of the procedure due to any etiology. Additional meta-analyses evaluated success rates of the procedure for Valsalva retinopathy and proliferative diabetic retinopathy (PDR). Secondary outcomes of interest included complications and reasons for failure. Results: Twenty-three studies with 291 eyes were included. The pooled success rate of Nd:YAG laser posterior membranotomy was 93.7% (95% CI, 89.3%-97.3%). Additional meta-analyses identified a success rate of 97.9% (95% CI, 91.9%-100%) with Valsalva retinopathy and 90.8% (95% CI, 77.8%-99.2%) with PDR. Reasons for a failed procedure included failure of drainage secondary to a clotted hemorrhage and nonclearing vitreous hemorrhage that necessitated vitrectomy. Reported complications included 1 macular hole, 2 epiretinal membranes, 2 retinal detachments, and 3 instances of metamorphopsia. Conclusions: Nd:YAG laser posterior membranotomy is a safe treatment option for macular preretinal hemorrhages. Drainage of the hemorrhage into the vitreous facilitates absorption and can restore a patient's vision.

Keywords: Nd:YAG laser posterior hyaloidotomy; Nd:YAG laser posterior membranotomy; premacular hemorrhage; subhyaloid hemorrhage.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article.

Figures

Summary: The flowchart presents a systematic process for selecting studies for qualitative and quantitative meta-analysis using PRISMA criteria.
Figure 1.
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flowchart.
(1) Forest plot meta-analysis diagram for the success of Nd:YAG laser posterior membranotomy treatment for any cause of premacular hemorrhage. (2) Funnel plot of studies showing the success rate.
Figure 2.
(A) Forest plot meta-analysis of proportions of the pooled success rates of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior membranotomy for premacular hemorrhage due to any etiology. Each study is shown by the last name of the first author and the proportion with 95% CIs. Summary proportions with 95% CIs are also shown. (B) Funnel plot of the studies included in the meta-analysis. Abbreviation: IV, inverse variance.
Forest plot showing proportionate success rates of Nd:YAG laser treatment for premacular hemorrhage due to Valsalva retinopathy, based on total events, weighted outcomes, and 95% confidence intervals; funnel plot visualizing potential publication bias.
Figure 3.
(A) Forest plot meta-analysis of proportions of the pooled success rates of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior membranotomy for premacular hemorrhage due to do Valsalva retinopathy. Each study is shown by the last name of the first author and the proportion with 95% CIs. Summary proportions with 95% CIs are also shown. (B) Funnel plot of the studies included in the meta-analysis. Abbreviation: IV, inverse variance.
Graph compares posterior membranotomy success rates using Nd:YAG laser treatment for diabetic retinopathy in various studies through forest plot and funnel plot, showing confidence intervals and study names.
Figure 4.
(A) Forest plot meta-analysis of proportions of the pooled success rates of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior membranotomy for premacular hemorrhage due to do proliferative diabetic retinopathy. Each study is shown by the last name of the first author and the proportion with 95% CIs. Summary proportions with 95% CIs are also shown. (B) Funnel plot of the studies included in the meta-analysis. Abbreviation: IV, inverse variance.
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