Neodymium:YAG laser treatment for premacular hemorrhage

To investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser in 13 eyes of 12 patients with 3 months follow-up. The study was conducted between January 2001 and December 2001. Thirteen eyes of 12 patients had a circumscribed premacular hemorrhage and were treated with Nd:YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from diabetic retinopathy (8 eyes), retinal macroaneurysm (2 eyes), acute myeloblastic leukemia (AML) (2 eyes), and branch retinal vein occlusion (1 eye). The size of the hemorrhage was expressed in disc diameters. The success of the laser procedure was defined as clearing of premacular hemorrhage within 3 months. By this definition drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser succeeded within three months in eleven out of thirteen eyes treated without requiring further membranotomy. One eye had persistent, dense, and nonclearing vitreous opacity for at least 3 months. One clotted hemorrhage did not drain into the vitreous. Overall visual improvement was best in eyes with AML and macroaneurysm. During the follow-up, neither macular epiretinal membranes nor tractional retinal detachments occurred in any eyes. Drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser is a viable treatment alternative for eyes with recent bleeding. However, 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.