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(A) Fundus photograph of the right eye showed a huge sub-internal limiting membrane (ILM) hemorrhage in the temporal macular area. (B) Spectral domain optic coherence tomography (OCT) revealed a dome-shaped hypo-reflective area, consistent with blood beneath a hyper-reflective band at the macula. (C) Spectral domain OCT reveals two distinct membranes: the more apparent and reflective one was identified as ILM (red arrow), and the other slight and patched membrane was identified as posterior hyaloid (yellow arrow). (D) The hemorrhage was drained inferiorly after the argon laser procedure. (E) Fundus photograph reveals strong resolution of the hemorrhage after three weeks. (F,G) OCT reveals laser perforation points along the ILM and hyaloid after three weeks. (H) There was no hemorrhage in fundus photograph after two years. (I) Pseudo-hole and no reattachment of ILM are observed in the temporal macular area in the last OCT. (J) OCT reveals that the detached ILM was attached to the posterior hyaloid and formation of no epiretinal membrane after two years.
Contexts in source publication
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... 35-year-old man presented with sudden blurred vision in the right eye that occurred one day before examination. Dilated fundus examination of the right eye showed a well-circumscribed large sub-ILM hemorrhage in the tem- poral macular area (Fig. 1A). Fluid was noted in the upper part of the hemorrhage. OCT (Spectralis; Heidelberg Engi- neering, Heidelberg, Germany) revealed a dome-shaped hypo-reflective area, consistent with blood beneath a hy- per-reflective band at the macula (Fig. 1B). OCT scans just above the level of sedimented blood revealed two distinct membranes overlying ...
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... of the right eye showed a well-circumscribed large sub-ILM hemorrhage in the tem- poral macular area (Fig. 1A). Fluid was noted in the upper part of the hemorrhage. OCT (Spectralis; Heidelberg Engi- neering, Heidelberg, Germany) revealed a dome-shaped hypo-reflective area, consistent with blood beneath a hy- per-reflective band at the macula (Fig. 1B). OCT scans just above the level of sedimented blood revealed two distinct membranes overlying a preretinal hemorrhage. The mem- brane on the retinal side, more apparent and reflective, was identified as ILM. The slight and patchy overlying mem- brane was identified as posterior hyaloid, and a mild vitre- ous hemorrhage was noted (Fig. ...
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... macula (Fig. 1B). OCT scans just above the level of sedimented blood revealed two distinct membranes overlying a preretinal hemorrhage. The mem- brane on the retinal side, more apparent and reflective, was identified as ILM. The slight and patchy overlying mem- brane was identified as posterior hyaloid, and a mild vitre- ous hemorrhage was noted (Fig. 1C). A dense preretinal hemorrhage produced shadowing that precluded analysis of the retina and subretinal space. We used AGL photoco- agulation (Lightlas 532 Green Laser; Lightmed, San Clem- Korean J Ophthalmol 2015;29 (6) ente, CA, USA) to perforate the hyaloid and ILM in order to drain the sub-ILM blood into the vitreous cavity. Four ...
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... the sub-ILM blood into the vitreous cavity. Four exposures of AGL were performed at the inferior margin of the hematoma's anterior surface with a spot size of 100 µm, exposure duration of 0.1 seconds, and power of 200 mW. Patient informed consent was obtained. Consequent- ly, the hemorrhage was rapidly drained inferiorly into the vitreous cavity (Fig. 1D). Fundus photography revealed strong resolution of the hemorrhage (Fig. 1E). OCT re- vealed laser perforation points along the ILM and hyaloid (Fig. 1F). The hyporeflective space between the ILM and the nerve fiber layer was possibly due to the presence of re- sidual blood. In addition, blood in the vitreous cavity was still observable ...
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... at the inferior margin of the hematoma's anterior surface with a spot size of 100 µm, exposure duration of 0.1 seconds, and power of 200 mW. Patient informed consent was obtained. Consequent- ly, the hemorrhage was rapidly drained inferiorly into the vitreous cavity (Fig. 1D). Fundus photography revealed strong resolution of the hemorrhage (Fig. 1E). OCT re- vealed laser perforation points along the ILM and hyaloid (Fig. 1F). The hyporeflective space between the ILM and the nerve fiber layer was possibly due to the presence of re- sidual blood. In addition, blood in the vitreous cavity was still observable on the OCT (Fig. 1G). At a two-year fol- low-up visit, visual acuity was ...
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... size of 100 µm, exposure duration of 0.1 seconds, and power of 200 mW. Patient informed consent was obtained. Consequent- ly, the hemorrhage was rapidly drained inferiorly into the vitreous cavity (Fig. 1D). Fundus photography revealed strong resolution of the hemorrhage (Fig. 1E). OCT re- vealed laser perforation points along the ILM and hyaloid (Fig. 1F). The hyporeflective space between the ILM and the nerve fiber layer was possibly due to the presence of re- sidual blood. In addition, blood in the vitreous cavity was still observable on the OCT (Fig. 1G). At a two-year fol- low-up visit, visual acuity was stable at 1.0, and the patient did not mention any symptoms of metamorphopsia. ...
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... Fundus photography revealed strong resolution of the hemorrhage (Fig. 1E). OCT re- vealed laser perforation points along the ILM and hyaloid (Fig. 1F). The hyporeflective space between the ILM and the nerve fiber layer was possibly due to the presence of re- sidual blood. In addition, blood in the vitreous cavity was still observable on the OCT (Fig. 1G). At a two-year fol- low-up visit, visual acuity was stable at 1.0, and the patient did not mention any symptoms of metamorphopsia. Al- though the hemorrhage was completely resolved (Fig. 1H), laser perforation points were incurred during the proce- dure, and a lamellar hole and failed reattachment of ILM were observed in the temporal ...
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... ILM and the nerve fiber layer was possibly due to the presence of re- sidual blood. In addition, blood in the vitreous cavity was still observable on the OCT (Fig. 1G). At a two-year fol- low-up visit, visual acuity was stable at 1.0, and the patient did not mention any symptoms of metamorphopsia. Al- though the hemorrhage was completely resolved (Fig. 1H), laser perforation points were incurred during the proce- dure, and a lamellar hole and failed reattachment of ILM were observed in the temporal macular area in the OCT at final follow-up (Fig. 1I). The OCT also revealed that the de- tached ILM had attached to the posterior hyaloid (Fig. 1J). The anatomical location of premacular ...
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... visual acuity was stable at 1.0, and the patient did not mention any symptoms of metamorphopsia. Al- though the hemorrhage was completely resolved (Fig. 1H), laser perforation points were incurred during the proce- dure, and a lamellar hole and failed reattachment of ILM were observed in the temporal macular area in the OCT at final follow-up (Fig. 1I). The OCT also revealed that the de- tached ILM had attached to the posterior hyaloid (Fig. 1J). The anatomical location of premacular hemorrhage, ei- ther under the ILM (sub-ILM) or subhyaloid, is still con- troversial and is not possible to distinguish using indirect fundus examination [1,2]. Intraoperative findings and time-domain ...
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... Al- though the hemorrhage was completely resolved (Fig. 1H), laser perforation points were incurred during the proce- dure, and a lamellar hole and failed reattachment of ILM were observed in the temporal macular area in the OCT at final follow-up (Fig. 1I). The OCT also revealed that the de- tached ILM had attached to the posterior hyaloid (Fig. 1J). The anatomical location of premacular hemorrhage, ei- ther under the ILM (sub-ILM) or subhyaloid, is still con- troversial and is not possible to distinguish using indirect fundus examination [1,2]. Intraoperative findings and time-domain and spectral domain OCT images in recent articles support previous histologic reports of ...
Citations
... It causes rapid resolution of the hemorrhage and vision restoration [ Fig. 3c-f]. Following are some general tips for using the disruptive laser: (a) select a location that is away from the fovea, at the dependent section of the bleed, and ideally away from a major blood vessel; [40] (b) execute in hemorrhages larger than 3 disc diameter; this size has a cushioning effect and prevents injury to the underlying retina; [41] (c) it is preferable to increase energy gradually after starting low; (d) if the surface is not penetrated with 12 mJ, it is unlikely to be perforated with stronger energy. [40] However, energy levels up to 50 mJ have been attempted without apparent retinal injury. ...
Quick Response Code: Clinically, hemorrhages at the vitreoretinal interface have been termed as 'pre-retinal' in location. However, there is a careful distinction to be made between sub-hyaloid and sub-internal limiting membrane (ILM) planes of blood collection. In the past half-century, a body of literature has accrued on sub-internal limiting membrane hemorrhage. We characterize the etiopathological, clinical, anatomical, and imaging characteristics of this entity (often misconstrued as sub-hyaloid hemorrhage). Management decisions are briefly described, and a unifying term of sub-internal limiting membrane macular hemorrhage is proposed to aid in further research.
... 19 Tirhis H. ve arkadaşlarının yaptığı çalışmada valsalva retinopatisine bağlı subilm hemorajisi olan bir hastaya argon lazer kullanılarak internal limitan membranotomi ile arka hyaloidotomi uygulanmış ve hemoraji kaybolmuştur. 20 Gebe olup valsalva retinopatisine bağlı oluşan makulayı içeren preretinal hemorajilerde tedavi seçeneği olarak gözlemi seçen olgu sunumlarından Al-Mujaini AS. ve ark.'nın yaptığı olgu sunumunda hemoraji 1 ay sonra, 3 Choudhry ve ark.'nınkinde ise hemoraji 5 ay sonra kaybolmuştur. 5 Erdurman FC. ve ark.'nın yaptığı olgu sunumunda ise valsalva retinopatisine bağlı gelişen makulayı içeren subhyaloid ve intravitreal hemorajisi olan gebe bir hastada tedavi seçeneği olarak Nd:YAG lazer kullanılmış ve 3 hafta sonra hemoraji kaybolmuştur. ...
... However, in some observed cases, irreversible visual impairment may occur because of macular pigmentary changes, epiretinal membrane (ERM) formation, or the toxicity of hemoglobin and iron on retina [11][12][13]. Other treatment options such as Nd: YAG laser membranotomy [14], vitrectomy [15], intravitreal injection of ranibizumab [16], preumatic displacement of the hemorrhage by gas and tissue plasminogen activator [17] and argon green laser [18] were recommended in Valsalva retinopathy, while not reported in FRAT patient until now. The other particularity of our case was that this FRAT patient was under observation for the little sub-ILM hemorrhages as well as Nd: YAG for the maximum premacular sub-ILM hemorrhages. ...
Background:
Bilateral and multiple Valsalva-related sub-internal limiting membrane (ILM) hemorrhages in a familial retinal arteriolar tortuosity (FRAT) patient is rare, and we treated this patient by both observation and Neodymium yttrium aluminum garnet (Nd: YAG) laser membranotomy methods.
Case presentation:
A 13-year-old female student presented with sudden visual loss and central scotoma in both eyes after running 800 m at the school gym. The examination revealed six sub-ILM hemorrhages with the biggest hemorrhage measuring approximately 1.5-disc diameters (DD) in the right eye and two sub-ILM hemorrhages with the biggest one measuring 5.5 DD in the left eye. The patient was diagnosed as having Valsalva retinopathy associated with FRAT. Nd: YAG laser membranotomy was performed at the biggest hemorrhages and the rest hemorrhages were treated with observation in both eyes. The visual acuity recovered to 20/16 in the right eye and 20/20 in the left eye. Epiretinal membrane (ERM) formation was observed in the left eye.
Conclusions:
Nd: YAG laser could be considered for treating premacular hemorrhage in FRAT patient especially when a quick vision recovery was needed. This is the first reported case of a FRAT patient suffering from bilateral and multiple Valsalva-related sub-ILM hemorrhages which were treated by both observation and Nd: YAG laser treatment.
... Se observa una línea hiperreflectiva, gruesa y brillante, que se continua con la retina adyacente y corresponde a la MLI, mientras que el espacio hiporreflectivo por debajo de la misma se corresponde con el domo hemorrágico. débilmente hiperreflectiva, discontinua y delgada 6,7 . En nuestro caso, la OCT (Fig. 3) muestra que la hemorragia se encuentra por debajo de una línea hiperreflectiva, brillante y compacta, que se continúa con el resto del tejido retiniano adyacente, por lo que se trataría de una hemorragia de ubicación sub-MLI. ...
19-year-old male under treatment for bulimia came for sudden decrease of the visual acuity (VA) of the left eye (LE) after an episode of severe vomit. The LE vision was of hand motion and the fundus showed a sub internal limiting membrane (sub-ILM) hemorrhage of 14 disc diameters. We decided to use Nd-YAG laser on the membrane, obtaining the complete drainage of the hemorrhage and immediate recovery of the LE VA (20/20). Conclusion: Nd-YAG laser treatment is recommended for young and active patients in cases of sub-ILM hemorrhage in the context of Valsalva’s retinopathy, due to its effective results and minimal risk.
... If it is a sub-ILM hemorrhage, the blood will be observed as a hyporreflective space below a thick and bright hyperreflective line, with continuous borders and well delimitated, corresponding to the ILM. However, the posterior hyaloid will be observed as a weakly hyperreflective, discontinuous and thin line 6,7 . In our case, OCT (Fig. 3) showed that the hemorrhage is under a hyperreflective, bright and compact line that continues with the rest of the adjacent retinal tissue, suggesting an hemorrhage located sub-ILM. ...
... Valsalva retinopatisinin tedavi seçenekleri arasında gözlem (3,5,8,18), Nd:YAG lazer (6,19), argon lazer (7,20), pnömatik retinopeksi (21), pnömatik retinopeksi ve doku plazminojen aktivatörü kullanımı (22) ve pars plana vitrektomi (23) yer almaktadır. Valsalva retinopatisine bağlı gelişen preretinal hemorajilerde tedavi seçeneği olarak göz-lemi seçen olgu sunumlarından Dursun A. ve arkadaşlarının yaptığı olgu sunumunda hemoraji 6 ay sonra (8), Kılıç R. ve arkadaşlarınınkinde de hemoraji 6 ay sonra kaybolmuştur (18). ...
... Pérez-Rico C. ve arkadaşlarının yaptığı olgu sunumunda valsalva retinopatisine bağlı gelişen preretinal hemorajide tedavi seçeneği olarak Nd:YAG lazer kullanılmış ve hemoraji 1 ay sonra kaybolmuştur (19). Tirhis H. ve arkadaşlarının yaptığı çalışmada valsalva retinopatisine bağlı subilm hemorajisi olan bir hastaya argon lazer kullanılarak internal limitan membranotomi ile arka hyaloidotomi uygulanmış ve hemoraji kaybolmuştur (20). Gebe olup valsalva retinopatisine bağlı oluşan makulayı içeren preretinal hemorajilerde tedavi seçeneği olarak gözlemi seçen olgu sunumlarından Al-Mujaini AS. ve arkadaşlarının yaptığı olgu sunumunda hemoraji 1 ay sonra (3), Choudhry N. ve arkadaşlarınınkinde ise hemoraji 5 ay sonra kaybolmuştur (5). ...
Z Bu raporda gebelik kaynaklı valsalva retinopatisine bağlı gelişen subhyaloid, subinternal limitan membran, intravitreal hemorajinin Nd:YAG lazer internal limitan membranotomi ve arka hyaloidotomi ile başarılı bir şekilde drene edilmesinin sunulması amaçlanmıştır. 26 yaşındaki 33 haftalık gebe sağ gözde ani görme kaybı ile kliniğimize başvurdu. Alınan anamnezde arabada yapılan ani fren esnasında 5 yaşındaki yeğeninin kafasının hastanın karnına çarptığı öğrenildi. Yapılan oftalmolojik muayenesinde makulayı içine alan subhyaloid, subinternal limitan membran, intravitreal hemoraji saptandı. Hastaya Nd:YAG lazer internal limitan membranotomi ve arka hyaloido-tomi uygulandı. Hemoraji vitreus içine drene oldu ve 10 gün içerisinde tamamen temizlendi. Nd:YAG lazer internal limitan membrano-tomi ve arka hyaloidotomi gebelikte oluşan valsalva retionopatisine bağlı subhyaloid ve subinternal limitan membran hemorajinin hızlı ve etkin bir şekilde kaybolmasını sağlayan, komplikasyon oranı düşük bir tedavi seçeneği olarak düşünülebilir. Anahtar kelimeler: Valsalva retinopatisi, preretinal hemoraji, subhyaloid hemoraji, subinternal limitan membran hemoraji, Nd:YAG lazer. ABSTRACT In this report, we aimed to present successful treatment of subhyaloidal, subinternal limiting membrane, intravitreal hemorrhage secondary to valsalva maneuver due to pregnancy with Nd:YAG laser internal limiting membranotomy and posterior hyaloidotomy. A 26 year-old, 33-week pregnant woman complained of sudden vision loss in her right eye. We learned in the anamnesis that her 5 year-old nephew's head hit the patient's stomach during a sudden braking in the car. In ophthalmological examination subhyaloidal, subinternal limiting membrane, intravitreal hemorrhage in macular area were detected. Nd:YAG laser internal limiting membranotomy and posterior hyaloidotomy were applied. The hemorrhage was drained into the vitreous and cleaned completely within ten days. Nd: YAG laser can be considered as a low-complication treatment option that allows rapid and effective loss of subhyaloidal and subinternal limiting membrane hemorrhage related to valsalva maneuver in pregnancy.
“Nonmechanical closed-globe injuries of the inner coatings (the ciliary body, the choroid and the retina) of the globe” has not been defined in the classifications of both BETT (Birmingham Eye Trauma Terminology) (Kuhn et al. 2008) and OTCS (Ocular Trauma Classification System) (Pieramici et al. 1997) clearly, and, besides, those can be categorized as follows.
