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 subhyaloid hemorrhage into the vitreous with an Nd:YAG laser in a large series of patients with long-term follow-up. METHODS: A retrospective review 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 16 eyes, visual acuity improved within 1 month. Four eyes had persistent, dense, nonclearing vitreous opacity for at least 3 months and finally required vitrectomy. One clotted hemorrhage did not drain into the vitreous. Final visual outcome was determined by the underlying diagnosis, such as Valsalva retinopathy (7 eyes), diabetic retinopathy (7 eyes), 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 patient. CONCLUSIONS: Drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser is a viable treatment alternative for eyes with recent bleeding. However, a macular hole and a retinal detachment were observed as complications. Thus, to establish Nd:YAG laser treatment as a routine procedure, the risks and benefits have to be weighed in a randomized trial and compared with those of deferral of treatment or primary vitrectomy.

[Risk factors for surgical failures in rhegmatogenous retinal detachment]. / Risikofaktoren für operative Misserfolge bei rhegmatogener Netzhautablösung.

BACKGROUND: The evaluation of further risc factors predesposing failure in retinal detachment surgery than those already known to be associated with PVR was the goal of this retrospective study. PATIENTS AND METHODS: The data from 130 cases with unilateral rhegmatogenous retinal detachment treated initially with buckling procedures, were retrospectively reviewed to investigate pre-, intra- and postoperative factors which may predispose anatomical failure in retinal detachment surgery. None of the selected consecutively operated eyes had risk factors, which have already been associated with an unfavourable outcome, such as the presence of preoperative macular holes, PVR or assumed PVR-inducing factors, such as ocular trauma, giant retinal tears, vitreous hemorrhage, previous vitrectomy, cryopexy and laser photocoagulation. RESULTS: The anatomic success rate after scleral buckling procedures was 78.5% and the overall success rate after multiple surgery including vitrectomy increased to 94.6%. 102 (78.5%) cases, treated with a maximum of two scleral buclking operations were statistically compared to the 28 cases which needed further vitreoretinal surgery. The statistical analysis revealed as preoperative risk factors for failure in rhegmatogenous retinal detachment surgery 1) retinal detachment exceeding two retinal quadrants (p < 0.05) and 2) size of the retinal tear larger than 60 degrees (p < 0.05), whereas postoperative risk factors were 1) presence of subretinal hemorrhage (p < 0.01) and 2) persistent subretinal fluid at least two days after surgery (p < 0.01). Eyes with preoperative visual acuity less than 0.1, pseudophacic eyes with posterior chamber intraocular lenses and eyes with severe intraoperative hypotony also showed a tendency to unfavourable outcome, but without a statistically significant level. CONCLUSIONS: Possible ways of interfering in the retinal reattachment process and the clinical importance of these evaluated factors are discussed. They should be taken in consideration for the prognosis of the postoperative anatomical result and treatment modalities if further surgery is required.