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Michael W. Ulbig, MD; Georgios Mangouritsas, MD; H.-Hermann Rothbächer, MD; A. M. Peter Hamilton, FRCS, FRCOphth; J. Dominic McHugh, MD, FRCS, FRCOphth

Arch Ophthalmol. 1998;116:1465-1469.

Objective  To investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser in a large series of patients with long-term follow-up.

Methods  A retrospective review was conducted on 21 eyes with a circumscribed premacular subhyaloid hemorrhage of various causes. These eyes were treated with a pulsed Nd:YAG laser to drain the entrapped blood into the vitreous. The period of review ranged from 12 to 32 months (mean, 22 months).

Results  In 16 eyes, visual acuity improved within 1 month. Four eyes had persistent, dense, nonclearing vitreous opacity for at least 3 months and finally required vitrectomy. One clotted hemorrhage did not drain into the vitreous. Final visual outcome was determined by the underlying diagnosis, such as Valsalva retinopathy (7 eyes), diabetic retinopathy (7 eyes), branch retinal vein occlusion (4 eyes), and retinal macroaneurysm, Terson syndrome, or blood dyscrasia (1 eye each). Eyes with Valsalva retinopathy fared the best. Complications included a macular hole in 1 eye and a retinal detachment from a retinal break in a myopic patient.

Conclusions  Drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser is a viable treatment alternative for eyes with recent bleeding. However, a macular hole and a retinal detachment were observed as complications. Thus, to establish Nd:YAG laser treatment as a routine procedure, the risks and benefits have to be weighed in a randomized trial and compared with those of deferral of treatment or primary vitrectomy.

From the University Eye Hospital, Ludwig Maximilians University, Munich, Germany (Drs Ulbig, Mangouritsas, and Rothbächer); Moorfields Eye Hospital (Dr Hamilton), and Eye Department, King's College Hospital (Dr McHugh), London, England.

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