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LETTER TO THE EDITOR
Year : 2016  |  Volume : 64  |  Issue : 12  |  Page : 947

Comment on: Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report


ICARE Eye Hospital and Post Graduate Institute, Noida, Uttar Pradesh, India

Date of Web Publication23-Jan-2017

Correspondence Address:
Neha Goel
57, Sadar Apartments, Mayur Vihar Phase 1 Extension, New Delhi - 110 091
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.198852

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How to cite this article:
Goel N. Comment on: Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report. Indian J Ophthalmol 2016;64:947

How to cite this URL:
Goel N. Comment on: Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report. Indian J Ophthalmol [serial online] 2016 [cited 2020 May 30];64:947. Available from: http://www.ijo.in/text.asp?2016/64/12/947/198852

Sir,

I read with interest the article titled, “Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report” by Vaggu and Bhogadi.[1] In the absence of optical coherence tomography (OCT) images being provided in this report, I request further clarification on how the authors have labeled the bilateral macular hemorrhage as sub-internal limiting membrane (sub-ILM).

The distinction between sub-ILM and subhyaloid hemorrhage is difficult to define clinically. Although glistening reflexes and surface striae may point toward the hemorrhage being sub-ILM, the reliability of ophthalmoscopy in locating the plane of hemorrhage has been challenged.[2] If the presence of the detached posterior hyaloid face in the area of the hemorrhage can be documented using ultrasonography or OCT, it suggests that the hemorrhage is sub-ILM and not subhyaloid.[3] If two layers are not picked up, the presence of a dome-shaped convex cavity on OCT, with a hyperreflective anterior layer corresponding to the ILM, suggests that the hemorrhage is sub-ILM.[4] Thus, the hemorrhage [1] should be referred to as “preretinal” or “premacular,” in the absence of evidence suggesting that it is sub-ILM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Vaggu SK, Bhogadi P. Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report. Indian J Ophthalmol 2016;64:157-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Ulbig MW, Mangouritsas G, Rothbacher HH, Hamilton AM, McHugh JD. Long-term results after drainage of premacular subhyaloid hemorrhage into the vitreous with a pulsed Nd: YAG laser. Arch Ophthalmol 1998;116:1465-9.  Back to cited text no. 2
    
3.
Shukla D, Naresh KB, Kim R. Optical coherence tomography findings in valsalva retinopathy. Am J Ophthalmol 2005;140:134-6.  Back to cited text no. 3
    
4.
Goel N, Kumar V, Seth A, Raina UK, Ghosh B. Spectral-domain optical coherence tomography following Nd: YAG laser membranotomy in valsalva retinopathy. Ophthalmic Surg Lasers Imaging 2011;42:222-8.  Back to cited text no. 4
    




 

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