E. Ezra et al., IDENTIFYING MACULOPATHY AFTER NEODYMIUM-YAG MEMBRANOTOMY FOR DENSE DIABETIC PREMACULAR HEMORRHAGE, Ophthalmology, 103(10), 1996, pp. 1568-1574
Purpose: To assess the value of neodymium:YAG membranotomy in achievin
g rapid intravitreal dispersion of dense diabetic premacular hemorrhag
e and allowing the identification and treatment of maculopathy before
panretinal photocoagulation (PRP). Methods: A pilot study, in which ni
ne eyes with dense diabetic premacular hemorrhages were treated with n
eodymium:YAG membranotomy, is described, After intravitreal dispersion
of premacular blood, fundus examination and fluorescein angiography w
ere performed to identify neovascularization and macular edema. Macula
r photocoagulatian was performed before PRP in eyes with co-existing m
aculopathy and neovascularization. Results: Complete intravitreal disp
ersion was achieved in all eyes within 1 week. Clinically significant
macular edema was identified and treated, before PRP, in three eyes. N
o exacerbation of macular edema occurred after PRP, and visual acuity
was stabilized at pre-hemorrhage levels in seven eyes and to within on
e line in ?he remaining two eyes. No traction retinal detachments or r
ebleeding occurred, and vitrectomy was not required in any eye. Conclu
sions: Early neodymium:YAG membranotomy may obviate the need for early
vitrectomy for dense diabetic premacular hemorrhage, and allows early
identification and treatment of maculopathy, before PRP, thus reducin
g the risk of exacerbation after PRP. Further studies to evaluate this
treatment modality, particularly with respect to longterm Visual prog
nosis, appear warranted.