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Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage

BACKGROUND: Premacular subhyaloid hemorrhage results in a sudden profound loss of vision. Among the modalities for its treatment, Nd:YAG laser hyaloidotomy is a non invasive method enabling rapid drainage of the obstructed macular area and improved vision within days. This study was aimed to evaluat...

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Autores principales: Khadka, Deepak, Bhandari, Sanjeeb, Bajimaya, Sanyam, Thapa, Raba, Paudyal, Govinda, Pradhan, Eli
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835902/
https://www.ncbi.nlm.nih.gov/pubmed/27090882
http://dx.doi.org/10.1186/s12886-016-0218-0
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author Khadka, Deepak
Bhandari, Sanjeeb
Bajimaya, Sanyam
Thapa, Raba
Paudyal, Govinda
Pradhan, Eli
author_facet Khadka, Deepak
Bhandari, Sanjeeb
Bajimaya, Sanyam
Thapa, Raba
Paudyal, Govinda
Pradhan, Eli
author_sort Khadka, Deepak
collection PubMed
description BACKGROUND: Premacular subhyaloid hemorrhage results in a sudden profound loss of vision. Among the modalities for its treatment, Nd:YAG laser hyaloidotomy is a non invasive method enabling rapid drainage of the obstructed macular area and improved vision within days. This study was aimed to evaluate the efficacy, visual outcome and complications following Nd:YAG laser hyaloidotomy for premacular subhyaloid hemorrhage. METHODS: Patients with premacular subhyaloid hemorrhage of more than 3 disc diameters (DD) of various etiologies, attending Tilganga Institute of Ophthalmology, Nepal from August, 2014 to February, 2015, were included. A comprehensive ocular evaluation was conducted and fundus photographs were taken to measure the size of the subhyaloid hemorrhage. Optical coherence tomography (OCT) were performed before and after treatment and on subsequent follow up visits. Fundus fluorescence angiography was done whenever necessary. Q switched Nd:YAG laser was applied to create an opening in the posterior hyaloids membrane for draining subhyaloid hemorrhage. The main outcome measures were success rate in performing hyaloidotomy, drainage of subhyaloid blood into vitreous cavity and its resorption, improvement in visual acuity, need for further intervention and postoperative complications. RESULTS: There were 21 eyes of 19 patients, 17(89.48 %) male and 2(10.52 %) female. In 3, premacular subhyaloid hemorrhage was bilateral. Mean age was 41.68 ± 17.08 years and a mean duration of symptoms 15.04 days. Mean pretreatment hemorrhage was 6.27DD. Nd:YAG laser hyaloidotomy was successful in 19 eyes(86.4 %). In 2 patients, one each with Eales’ disease and retinal vein occlusion the procedure was unsuccessful, necessitating pars plana vitrectomy, while in a case with proliferative diabetic retinopathy (PDR), vitrectomy was resorted for non clearing vitreous hemorrhage. Vision improved from a median of 3/60 pre-operatively to 6/6, at 6 months follow up. At 3 months, 2 patients with Eales’ disease, one developed tractional detachment at macula while the other, an epiretinal membrane. No other complications were noted at 6 months. CONCLUSION: Nd:YAG laser hyaloidotomy is an inexpensive, effective and a safe outpatient procedure for premacular subhyaloid hemorrhage, producing rapid drainage with restoration of visual function avoiding more invasive procedures and enabling early assessment of the underlying retina. The final visual prognosis however, rests on the underlying cause of the subhyaloid hemorrhage and any accompanying retinal changes.
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spelling pubmed-48359022016-04-20 Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage Khadka, Deepak Bhandari, Sanjeeb Bajimaya, Sanyam Thapa, Raba Paudyal, Govinda Pradhan, Eli BMC Ophthalmol Research Article BACKGROUND: Premacular subhyaloid hemorrhage results in a sudden profound loss of vision. Among the modalities for its treatment, Nd:YAG laser hyaloidotomy is a non invasive method enabling rapid drainage of the obstructed macular area and improved vision within days. This study was aimed to evaluate the efficacy, visual outcome and complications following Nd:YAG laser hyaloidotomy for premacular subhyaloid hemorrhage. METHODS: Patients with premacular subhyaloid hemorrhage of more than 3 disc diameters (DD) of various etiologies, attending Tilganga Institute of Ophthalmology, Nepal from August, 2014 to February, 2015, were included. A comprehensive ocular evaluation was conducted and fundus photographs were taken to measure the size of the subhyaloid hemorrhage. Optical coherence tomography (OCT) were performed before and after treatment and on subsequent follow up visits. Fundus fluorescence angiography was done whenever necessary. Q switched Nd:YAG laser was applied to create an opening in the posterior hyaloids membrane for draining subhyaloid hemorrhage. The main outcome measures were success rate in performing hyaloidotomy, drainage of subhyaloid blood into vitreous cavity and its resorption, improvement in visual acuity, need for further intervention and postoperative complications. RESULTS: There were 21 eyes of 19 patients, 17(89.48 %) male and 2(10.52 %) female. In 3, premacular subhyaloid hemorrhage was bilateral. Mean age was 41.68 ± 17.08 years and a mean duration of symptoms 15.04 days. Mean pretreatment hemorrhage was 6.27DD. Nd:YAG laser hyaloidotomy was successful in 19 eyes(86.4 %). In 2 patients, one each with Eales’ disease and retinal vein occlusion the procedure was unsuccessful, necessitating pars plana vitrectomy, while in a case with proliferative diabetic retinopathy (PDR), vitrectomy was resorted for non clearing vitreous hemorrhage. Vision improved from a median of 3/60 pre-operatively to 6/6, at 6 months follow up. At 3 months, 2 patients with Eales’ disease, one developed tractional detachment at macula while the other, an epiretinal membrane. No other complications were noted at 6 months. CONCLUSION: Nd:YAG laser hyaloidotomy is an inexpensive, effective and a safe outpatient procedure for premacular subhyaloid hemorrhage, producing rapid drainage with restoration of visual function avoiding more invasive procedures and enabling early assessment of the underlying retina. The final visual prognosis however, rests on the underlying cause of the subhyaloid hemorrhage and any accompanying retinal changes. BioMed Central 2016-04-18 /pmc/articles/PMC4835902/ /pubmed/27090882 http://dx.doi.org/10.1186/s12886-016-0218-0 Text en © Khadka et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Khadka, Deepak
Bhandari, Sanjeeb
Bajimaya, Sanyam
Thapa, Raba
Paudyal, Govinda
Pradhan, Eli
Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage
title Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage
title_full Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage
title_fullStr Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage
title_full_unstemmed Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage
title_short Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage
title_sort nd:yag laser hyaloidotomy in the management of premacular subhyaloid hemorrhage
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835902/
https://www.ncbi.nlm.nih.gov/pubmed/27090882
http://dx.doi.org/10.1186/s12886-016-0218-0
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