LONG-TERM RESULTS AFTER DRAINAGE OF PREMACULAR SUBHYALOID HEMORRHAGE INTO THE VITREOUS WITH A PULSED ND-YAG LASER

Objective: To investigate the effects of drainage of premacular subhya loid hemorrhage into the vitreous with an Nd.YAG laser in a large seri es of patients with longterm follow-up. Methods: A retrospective revie w was conducted on 21 eyes with a circumscribed premacular subhyaloid hemorrhage of various causes. These eyes were treated with a pulsed Nd :YAG laser to drain the entrapped blood into the vitreous. The period of review ranged from 12 to 32 months (mean, 22 months). Results: In 1 6 eyes, visual acuity improved within 1 month. Four eyes had persisten t, dense, nonclearing vitreous opacity for at least 3 months and final ly required vitrectomy. One clotted hemorrhage did not drain into the vitreous. Final visual outcome was determined by the underlying diagno sis, such as Valsalva retinopathy (7 eyes), diabetic retinopathy (7 ey es), branch retinal vein occlusion (4 eyes), and retinal macroaneurysm , Terson syndrome, or blood dyscrasia (1 eye each). Eyes with Valsalva retinopathy fared the best. Complications included a macular hole in 1 eye and a retinal detachment from a retinal break in a myopic patien t. Conclusions: Drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser is a viable treatment alternative for ey es with recent bleeding. However, a macular hole and a retinal detachm ent were observed as complications. Thus, to establish Nd:YAG laser tr eatment as a routine procedure, the risks and benefits have to be weig hed in a randomized trial and compared with those of deferral of treat ment or primary vitrectomy.