PMC5602721_01
Fundus photographs before and after Nd:YAG laser membranotomy in Case 1. (A) Right eye with a dense and large premacular hemorrhage. (B) Late-phase fluorescein angiogram confirms Valsalva retinopathy. (C) One week after Nd:YAG laser membranotomy, the right eye showed very little residual hemorrhage.
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F1
The boat-shaped hemorrhage, which extended over the optic disc was a typical subhyaloid hemorrhage (Fig. 1A). No neovascularization, venous occlusion, or macroaneurysm was detected by fluorescein angiography (Fig. 1B). The blood was immediately drained into the vitreous cavity; by 1 week, it was mostly eliminated (Fig. 1C).
Optical coherence tomography (OCT) findings before and after Nd:YAG laser membranotomy in Case 1. (A) The very faint overlying membrane is the posterior hyaloid (solid arrow), and on the retina aspect is the more reflective internal limiting membrane (ILM) (dotted arrow). The infrared image shows the location of the vertical and horizontal spectral domain-OCT (SD-OCT) scan area. (B) One week after Nd:YAG laser membranotomy, the detached ILM (dotted arrow) was present and residual blood was found in the subhyaloidal space (asterisk) in the lower part.
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F2
The SD-OCT scan (RTVue-100 OCT; Optovue Inc., CA, USA) of the region just at the upper margin of the hemorrhage revealed two distinct membranes overlying the preretinal hemorrhage (Fig. 2A). The SD-OCT distinguished the detached hyperreflective ILM from the underlying retinal layers and the remaining blood in the subhyaloidal space (Fig. 2B).
PMC5602721_02
Fundus photographs before and after Nd:YAG laser membranotomy in Case 2. (A) Macroaneurysm in the left eye with a dense premacular hemorrhage. (B) Late-phase fluorescein angiogram shows dye leaking from the macroaneurysm on the upper macular branch artery. (C) One week after Nd:YAG laser membranotomy, a residual yellowish hematoma was present in the paracentral area of the left eye.
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F3
A dense dark-red premacular hemorrhage with macroaneurysm was confirmed by fluorescein angiography (Fig. 3A and B). One week later, her visual acuity improved to 20/200 with a substantially decreased hemorrhage, but a residual yellowish hematoma was in the para-central area (Fig. 3C).
Optical coherence tomography (OCT) findings before and after Nd:YAG laser membranotomy in Case 2. (A) spectral domain-OCT (SD-OCT) reveals that the fainter reflecting posterior hyaloid in the upper border (solid arrow) is fused with the internal limiting membrane (ILM) (dotted arrow) over the preretinal hemorrhage. The infrared image shows the location of the vertical and horizontal SD-OCT scan area. (B) The SD-OCT image shows a residual sub-ILM hemorrhage (asterisk) and a dense blood clot (pound sign) in the lower part.
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F4
The SD-OCT scan also revealed a faint overlying membrane (i.e., posterior hyaloid) fused with the hyperreflective membrane (i.e., ILM) around the upper margin of the hemorrhage (Fig. 4A). The OCT image showed a blood clot in the lower part under the hyperreflective ILM and remaining blood in the upper part, which were not easily detected by indirect ophthalmoscopy (Fig. 4B).