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Photo Essay
November 1998

Dense Subhyaloid Hemorrhage or Subinternal Limiting Membrane Hemorrhage in the Macula Treated by Nd:YAG Laser

Arch Ophthalmol. 1998;116(11):1542-1543. doi:10.1001/archopht.116.11.1542

A 22-YEAR-OLD woman in her seventh month of pregnancy complained of a sudden decrease of visual acuity in her right eye. She was known to have myopia and astigmatism. Prior to the current complaint her visual acuity was 20/30 OU with correction from −3.25 to 1.5 × 180° OD and from −3.25 to 2.0 × 165° OS. Otherwise, both eyes were normal and no systemic disease was noted. Visual acuity was 1/60 OD, the anterior segment was normal, and an extensive preretinal hemorrhage covering the posterior pole was seen in the fundus (Figure 1). Corrected visual acuity was 20/30 OS and the anterior segment and fundus were normal. The patient was treated by Nd:YAG laser aimed at the anterior surface of the preretinal hemorrhage, using a fundus contact lens with pulse power starting from 1.3 mJ and increasing gradually. At a power of 2.7 mJ, 3 small openings were created in the posterior hyaloid and blood was flowing into the lower vitreous cavity (Figure 2). An hour after treatment, corrected visual acuity improved to 20/40 OD and the preretinal blood was released into the lower vitreous cavity. No pathologic condition was visible in the retina and no bleeding origin was detected. Findings from general physical and neurological examinations and blood tests, including complete blood cell count, platelet count, blood glucose, prothrombin time, and partial thromboplastin time, showed no abnormalities. There was no history of Valsalva maneuver prior to the dense premacular hemorrhage in the present illness.

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