PMC5646296_01
A 55-year-old man had sudden decreased visual acuity in the right eye. (a) Fundus photography of the right eye shows multilevel macular hemorrhage occupying nearly the half of macular area within the vascular arcade. Note the round dark hemorrhage which was considered to be a hemorrhagic detachment of ILM and a more superficially situated lighter-colored hemorrhage considered to be subhyaloid hemorrhage. (b) An immediate stream of blood into the vitreous through the photodisruption cleft is seen after the laser treatment.
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Fundus examination showed a round dark hemorrhage which was considered to be a hemorrhagic detachment of the ILM and a more superficially situated lighter-colored hemorrhage considered to be subhyaloid hemorrhage, covering nearly half of the macular area within the vascular arcade (Figure 1(a)). Nd:YAG laser photodisruption was performed in the lower and most prominent area of the hemorrhage, and premacular hemorrhage immediately drained through the photodisruption cleft into the vitreous cavity (Figure 1(b)). No evidence of damage to the retina or choroid due to treatment was observed.
One month after laser treatment, (a) fundus photography of the right eye shows only small amount of residue blood at the lower edge of the detached ILM. (b, c) Fluorescein angiography shows a round area of hyperfluorescence which is prominent in venous phase and corresponds to a macroaneurysm of the macular branch of the superotemporal vein at the bifurcation site. (d) Optical coherence tomography demonstrates the detached and wrinkled ILM (white arrow) extending from the site of the macroaneurysm (yellow arrow) to the inferior margin of the residual sub-ILM blood causing a shadowing effect (star) in the macula.
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At the first-month follow-up, BCVA in the right eye improved to 20/25 and only a small amount of residue blood was observed at the lower edge of the detached ILM (Figure 2(a)). Also, ILM wrinkling was observed at the macula where the preretinal hemorrhage cleared (Figure 2(a)). Fluorescein angiogram revealed a round area of hyperfluorescence corresponding to a macroaneurysm of the macular branch of the superotemporal vein at the bifurcation site (Figures 2(b) and 2(c)). Optical coherence tomography demonstrated detachment of the wrinkled ILM extending from the site of the macroaneurysm to the inferior margin of the residual sub-ILM blood (Figure 2(d)).