|LETTER TO THE EDITOR
|Year : 2016 | Volume
| 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 Publication||23-Jan-2017|
57, Sadar Apartments, Mayur Vihar Phase 1 Extension, New Delhi - 110 091
Source of Support: None, Conflict of Interest: None
|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 Oct 31];64:947. Available from: https://www.ijo.in/text.asp?2016/64/12/947/198852
I read with interest the article titled, “Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report” by Vaggu and Bhogadi. 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. 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. 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. Thus, the hemorrhage  should be referred to as “preretinal” or “premacular,” in the absence of evidence suggesting that it is sub-ILM.
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Conflicts of interest
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| References|| |
Vaggu SK, Bhogadi P. Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report. Indian J Ophthalmol 2016;64:157-9.
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.
Shukla D, Naresh KB, Kim R. Optical coherence tomography findings in valsalva retinopathy. Am J Ophthalmol 2005;140:134-6.
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.