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Surgical and Nonsurgical Treatment of Pre-retinal Hemorrhages

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Management of Macular Hemorrhage

Abstract

Pre-retinal and sub-inner limiting membrane (ILM) hemorrhages are defined as extravasal blood under the posterior hyaloid and under the ILM, respectively. Causes include Terson’s syndrome, valsalva retinopathy, proliferative diabetic retinopathy, and proliferative retinopathy after retinal vein occlusions. Pre-retinal hemorrhages themselves often resolve spontaneously without sequel. However, this can take many months during which the patient might remain severely visually impaired. The treatments commonly used to expedite the recovery are Nd:YAG membranotomy and vitrectomy. Nd:YAG membranotomy punctures the membrane that confines the blood in front of the retina and releases it into the vitreous where it rapidly dilutes. It should be performed within about 1 month from symptom onset. After that the blood has likely clotted and tends to be refractory to a Nd:YAG membranotomy. In these cases and in the presence of additional pathologies that need to be surgically addressed, a vitrectomy should be considered. A vitrectomy is the most reliable way to remove the hemorrhage and allows for additional procedures such as intraoperative photocoagulation, membrane peeling, tamponades, and intravitreal drug delivery.

While the prognosis for pre-retinal and sub-ILM hemorrhages per se with and without treatment is good, the ultimate outcome largely depends on the ocular and neurologic comorbidities of the patient.

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Authors and Affiliations

  1. Department of Ophthalmology, Medical University of Graz/Austria, Graz, Austria

    Gerald Seidel M.D., P.D., Dr.Sc., F.E.B.O. & Anton Haas M.D., P.D.

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  1. Gerald Seidel M.D., P.D., Dr.Sc., F.E.B.O.
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  2. Anton Haas M.D., P.D.
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Correspondence to Gerald Seidel M.D., P.D., Dr.Sc., F.E.B.O. .

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  1. Augenklinik des Klinikums Ludwigshafen, Ludwigshafen, Germany

    Lars-Olof Hattenbach

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Seidel, G., Haas, A. (2018). Surgical and Nonsurgical Treatment of Pre-retinal Hemorrhages. In: Hattenbach, LO. (eds) Management of Macular Hemorrhage. Springer, Cham. https://doi.org/10.1007/978-3-319-65877-3_6

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  • DOI: https://doi.org/10.1007/978-3-319-65877-3_6

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