IDENTIFYING MACULOPATHY AFTER NEODYMIUM-YAG MEMBRANOTOMY FOR DENSE DIABETIC PREMACULAR HEMORRHAGE

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.