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Bulgarian Review of Ophthalmology

Nd:YAG laser vitreolysis in the treatment of premacular subhyaloid hemorrhage

Martina Milkovska, Ilian Shandurkov


Introduction: Preretinal subhyaloid hemorrhage forms in bursa premacularis where, in an area of localized detachment of the vitreous from the retina, blood accumulates between the macula and the posterior hyaloid leading to a sudden painless loss of vision.

Aim: The aim of this article is to present an advanced method of laser treatment of subhyaloid hemorrhages located in bursa premacularis with neodymium:yttrium alluminum garnet (Nd:YAG) laser vitreolysis.

Materials and Methods: Three eyes of three patients with subhyaloid hemorrhage and a history of a sudden visual loss were studied. We followed up the patients by optical coherence tomography, visual acuity examination, ophthalmoscopy, and digital fundus photography. In all patients there was no tendency for spontaneous resorption of the blood collected in bursa premacularis. We performed Nd:YAG laser vitreolysis at a declivity spot in the posterior hyaloid using power of 6 mJ.

Results: In two of the patients, a month after the laser treatment, there was complete visual recovery. The third patient had vitreous hemorrhage, diffuse preretinal hemorrhage with horizontal blood level and underlying choroidal neovascularization (CNV). We started conservative treatment of the vitreous hemorrhage followed by Nd:YAG laser vitreolysis, and three intravitreal pars plana anti-vascular endothelial growth factor (anti-VEGF) applications over three consecutive months. Visual acuity improved from counting fingers, PPLC, initially to 0.1 a week after the vitreolysis and 0.9 after the completion of the anti-VEGF treatment. In the absence of underlying aneurysm or choroidal rupture, we observed no recurrence of the hemorrhage or deterioration of the visual acuity in any of the patients during the follow-up period (1 to 5 years).

Discussion: Nd:YAG laser vitreolysis is a non-invasive procedure providing a way for the blood to drain into the vitreous cavity where it undergoes spontaneous resorption within a few weeks without complications. When used in combination with anti-VEGF in patients with neovascular form of age-related macular degeneration (AMD), it results in fast improvement in vision with minimal risk of complications.

Conclusion: Early application of Nd:YAG laser vitreolysis in recent subhyaloid hemorrhages is a quick, minimally invasive, and effective method of treatment. In combination with anti-VEGF, it is a method of choice for the treatment of subhyaloid hemorrhages in neovascular AMD.


Nd:YAG laser; vitreolysis; age-related macular degeneration; subhyaloid hemorrhage

Full Text


Khadka D, Bhandari S, Bajimaya S, Thapa R, Paudyal G, Pradhan E. Nd:YAG laser hyaloidotomy in the management of premacular subhyaloid hemorrhage. BMC Ophthalmol. 2016;16:41

Karagiannis D, Kontadakis GA, Flanagan D. ND:YAG laser for preretinal hemorrhage in diabetic retinopathy. Am J Ophthalmol Case Rep. 2018;10:8-9. doi: 10.1016/j.ajoc.2018.01.027.

Puthalath S, Chirayath A, Shermila MV, et al. Frequency-doubled Nd:YAG laser treatment for premacular hemorrhage. Ophthalmic Surg Lasers Imaging 2003;34(4):284-90.

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(11):1465-9. doi: 10.1001/archopht.116.11.1465.

Durukan AH, Kerimoglu H, Erdurman C, Demirel A, Karagul S. Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy 2008;22(2):214-8. doi: 10.1038/sj.eye.6702574.

Kuruvilla O, Munie M, Shah M, Desai U, Miller JA, Ober MD. Nd:YAG membranotomy for preretinal hemorrhage secondary to Valsalva retinopathy. Saudi J Ophthalmol. 2014;28(2):145-51. doi: 10.1016/j.sjopt.2014.02.006.

Kwok AK, Lai TY, Chan NR. Epiretinal membrane formation with internal limiting membrane wrinkling after Nd:YAG laser membranotomy in valsalva retinopathy. Am J Ophthalmol. 2003;136(4):763-6. doi: 10.1016/s0002-9394(03)00442-2.

Venkatesh R, Manoj S, Badella S, Das S, Tan CS. Rapid resolution of premacular haemorrhage after Nd:YAG laser posterior hyaloidotomy. Acta Ophthalmol Scand. 2007 Mar;85(2):216-7. doi: 10.1111/j.1600-0420.2006.00788.x.

Rennie CA, Newman DK, Snead MP, Flanagan DW. Nd:YAG laser treatment for premacular subhyaloid hemorrhage. Eye. 2001;15(Pt 4):519-24. doi: 10.1038/eye.2001.166.

Nazari H, Modarres-Zadeh M, Maleki A. Pharmacologic vitreolysis. J Ophthalmic Vis Res. 2010;5(1):44-52.

Raymond LA. Neodymium:YAG laser treatment for hemorrhages under the internal limiting membrane and posterior hyaloid face in the macula. Ophthalmology. 1995;102(3):406-11. doi: 10.1016/s0161-6420(95)31008-1.

Faulborn J. Behandlung einer diabetischen praemaculaeren Blutung mit dem Q-switched Neodym:YAG laser. Spektrum Augenheilkd. 1988;2:33-5.

Nilli-Ahmadabadi M, Lashay AR, Karkhaneh R, Manaviat MR. Nd-Yag laser application in premacular subhyaloid hemorrhage. Arch Iranian Med. 2004;7(3):206–9

Celebi S, Kükner AS. Photodisruptive Nd:YAG laser in the management of premacular subhyaloid hemorrhage. Eur J Ophthalmol. 2001;11(3):281-6. doi: 10.1177/112067210101100312.

Mennel S. Subhyaloidal and macular haemorrhage: localisation and treatment strategies. Br J Ophthalmol. 2007;91(7):850-2. doi: 10.1136/bjo.2007.114025.



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About The Authors

Martina Milkovska
VISION Eye Hospital

Ilian Shandurkov
VISION Eye Hospital