Hyaloidotomy for subhyaloidal hemorrhage: OCT findings of two different treatment modalities

Abstract

Premacular subhyaloidal hemorrhage typically causes acute profound visual deterioration. Common causes for a subhyaloidal hemorrhage are retinal arterial macroaneurysms, arterial hypertension, diabetic retinopathy, hematological disorders and ocular trauma [1], [2], [3], [4]. In healthy adults it can be caused by a Valsalva maneuver leading to spontaneous rupture of superficial retinal capillaries [5]. Using spectral-domain optical coherence tomography (SD-OCT) the anatomical location of the hemorrhage can be exactly determined.
Controversy still exists about the best time for treatment and the specific treatment modality [6], [7]. Nd:YAG-laser-hyaloidotomy has been suggested in recent years to facilitate blood drainage and restoring vision faster [8], [9]. Thanks to the introduction of SD-OCT we are now able to precisely image the site of laser impact and to compare different lasers used for hyaloidotomy. We describe a case where both diode- and Nd:YAG-laser treatment have been consecutively applied with only the latter being successful at drainage and showing a visible effect on SD-OCT.