Indian Journal of Ophthalmology

PHOTO ESSAY
Year
: 2018  |  Volume : 66  |  Issue : 9  |  Page : 1321--1322

Different responses to two consecutive Nd:YAG laser membranotomies at different locations in a 3-week-old sub-internal limiting membrane hemorrhage


Baek-Lok Oh1, Hyeong Gon Yu2,  
1 Department of Ophthalmology, Seoul National University College of Medicine, Seoul; Department of Ophthalmology, Armed Force Capital Hospital, Seongnam, Korea
2 Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

Correspondence Address:
Dr. Hyeong Gon Yu
Department of Ophthalmology, Seoul National University College of Medicine, 101 Yongon-dong, Chongno-gu, Seoul 110-744
Korea

Abstract




How to cite this article:
Oh BL, Yu HG. Different responses to two consecutive Nd:YAG laser membranotomies at different locations in a 3-week-old sub-internal limiting membrane hemorrhage.Indian J Ophthalmol 2018;66:1321-1322


How to cite this URL:
Oh BL, Yu HG. Different responses to two consecutive Nd:YAG laser membranotomies at different locations in a 3-week-old sub-internal limiting membrane hemorrhage. Indian J Ophthalmol [serial online] 2018 [cited 2022 Aug 9 ];66:1321-1322
Available from: https://www.ijo.in/text.asp?2018/66/9/1321/239348


Full Text



 Case



A 20-year-old male soldier, with a history of a series of episodes of vomiting 22 days ago, presented with a central scotoma in his left eye. His visual acuity was hand movements OS. Fundus examination revealed a boat-shaped large premacular hemorrhage, and spectral-domain optical coherence tomography demonstrated a sub-internal limiting membrane (ILM) hemorrhage [Figure 1]. Given the classical clinical presentation, a diagnosis of Valsalva retinopathy was made.{Figure 1}

Nd:YAG laser was applied in a single shot to the ILM surface, beginning at 1.7 mJ and titrated in 0.2–0.3 mJ steps, without effect. Finally, a single shot at 4.8 mJ led to successful photodisruption and some blood was noted flowing through the ILM opening. However, drainage was minimal due to clot formation. When the second shot at the same energy was applied at a different location on the dependent part of ILM covering thick hemorrhage to protect the underlying retina, blood began to drain smoothly into vitreous cavity [Figure 2]. Four days postprocedure, the corrected vision was 20/25 with near-complete clearing of the premacular region. Three weeks later, his vision was 20/20 with further clearing of the vitreous hemorrhage [Figure 3].{Figure 2}{Figure 3}

 Discussion



Nd:YAG membranotomy is a valuable treatment option for sub-ILM hemorrhage.[1],[2],[3] A duration of over 3 weeks is known to be a critical factor for failure of clearance of sub-ILM hemorrhage.[4],[5] In our patient with a 22-day-old hemorrhage, the responses to the two laser shots were totally different. It might be because the degree of blood clot formations was not homogenous within the hemorrhage. Some cumulative effect of the energy delivered by two laser shots might also have contributed to the disruption of partly coagulated blood, resulting in its successful drainage.

 Conclusion



An additional laser shot successfully evacuated a sub-ILM hemorrhage. This result of different responses to laser shots could be taken into consideration while managing a sub-ILM hemorrhage of over 3 weeks' duration.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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