ND-YAG LASER APPLICATION IN PREMACULAR SUBHYALOID HEMORRHAGE

Background – Premacular subhyaloid hemorrhage is one of the etiologies of sudden visual loss. It may be due to vascular or blood abnormalities or Valsalva retinopathy. Spontaneous absorption of blood may take months and result in macular complications and permanent impairment of vision. Posterior hyaloidotomy by Nd-YAG laser is an outpatient procedure which may obviate the need for more complex surgical interventions. This study evaluates the success of this approach in patients with premacular subhyaloid hemorrhage of different etiologies. Methods – In this interventional case-series study, 12 eyes of 12 patients with premacular subhyaloid hemorrhage were enrolled. All patients had a comprehensive ocular examination before the operation and color fundus photographs were obtained. Fluorescein angiography was performed when necessary. Hyaloidotomy was performed using Nd-YAG laser. Main outcome measures were: success rate in hyaloidotomy (based on release of blood into the vitreous cavity and its subsequent absorption) and improvement in visual acuity and possible complications. Results – Twelve eyes of 12 patients (16.7% males and 83.3% females) with premacular subhyaloid hemorrhage were enrolled. The mean age of the patients was 48.5 ± 10.33 years. The predisposing factor was diabetic retinopathy in eight (66.7%), macroaneurysm (due to hypertension) in one (8.3%), and Valsalva retinopathy in three (25%). Hyaloidotomy was successful in all (100%) of the patients and the trapped blood was released into the vitreous cavity and absorbed within 6 to 16 (average = 9) days. The range of preoperative visual acuity was hand motions to counting fingers at 3 meters which improved from 20/50 to 20/20 postoperatively. Compared with those with vascular pathologies, visual improvement was best in the patients with Valsalva retinopathy. No complications were observed during their average follow-up of 24.5 (range: 8 to 72) months. Conclusion – Nd-YAG laser hyaloidotomy in premacular subhyaloid hemorrhage is a simple, inexpensive outpatient procedure which results in rapid visual recovery and is relatively safe. Further controlled clinical trials are recommended.