Nd:YAG-laser membranotomy for long-term premacular hemorrhage (case report)

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Abstract

Premacular hemorrhages are accompanied by a sudden significant vision loss and may originate from by various causes, the most common of which are proliferative retinopathy associated with diabetic eye diseases, ischemic retinal vein occlusion, macroaneurysms, and Valsalva retinopathy. Small hemorrhages (less than 3 disc diameters) often resolve spontaneously, whereas large hemorrhages under the internal limiting membrane have a significantly reduced probability of spontaneous regression and increased risks of complications associated with the toxic effects of hemoglobin breakdown products. The main treatment method in these cases is Nd:YAG-laser membranotomy or hyaloidotomy. It allows effective and safe drainage of blood into the vitreous humor, where it is completely resorbed. The article presents a clinical case of a long-term premacular hemorrhage associated with retinal arterial macroaneurysm. Though Nd:YAG-laser membranotomy was performed late, it not only significantly improved visual functions, but also prevented invasive vitreal procedures. Three-year follow-up revealed no treatment complications.

About the authors

Aleksei A. Suetov

St. Petersburg Branch of The S. Fyodorov Eye Microsurgery Federal State Institution; State Scientific Research Test Institute of Military Medicine

Author for correspondence.
Email: ophtalm@mail.ru
ORCID iD: 0000-0002-8670-2964
SPIN-code: 4286-6100

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Taisiia A. Doktorova

St. Petersburg Branch of The S. Fyodorov Eye Microsurgery Federal State Institution

Email: taisiiadok@mail.ru
ORCID iD: 0000-0003-2162-4018
SPIN-code: 8921-9738

MD

Russian Federation, Saint Petersburg

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2. Fig. 2. Fundus image and linear scans (1–4) during structural OCT of the macular region when the patient applied to the St. Petersburg branch of the Scientific and Technical Complex 3.5 months after the onset of complaints. a — Retinal arterial macroaneurysm; b — internal limiting membrane on the structural section; c — deposits under the internal limiting membrane — degradation products of erythrocyte hemoglobin; d — shadow of the Weiss ring on the fundus.

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3. Fig. 3. Fundus images and structural OCT scans (1–4) after Nd:YAG laser membranotomy: before treatment (a), 5 min (b), 1 day (c), and 1 month (d) after treatment. White arrows indicate the puncture sites of the internal limiting membrane.

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4. Fig. 4. Fundus photograph, autofluorescence and structural OCT sections of the patient 3 years after Nd:YAG laser membranotomy: m — obliteration of arterial macroaneurysm with focal atrophy of the outer layers of the neuroretina; 1 — on the OCT section, the compacted internal limiting membrane is partially not adjacent to the retinal nerve fiber layer; 2 — the OCT section shows the puncture sites of the internal limiting membrane.

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5. Fig. 1. Macular OCT at initial presentation (a) and after 2 months (b); the quality of OCT images is low, signs of preretinal hemorrhage are observed; at month 2, the en face infrared image shows signs of forming hemorrhage.

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