Advertisement

Der Ophthalmologe

, Volume 115, Issue 12, pp 1059–1065 | Cite as

Lasermembranotomie beim Management einer akuten prämakulären Blutung

Fallvorstellung und Überblick zum Vorgehen
  • M. Roth
  • L. Eisenkopf
  • D. Engineer
  • J. C. Schmidt
Kasuistiken
  • 49 Downloads

Zusammenfassung

Eine akute prämakuläre Blutung kann in Zusammenhang mit vasoproliferativen retinalen Veränderungen, Gefäßanomalien oder nach einem Valsalva-Manöver auftreten. Die Diagnose wird im Rahmen der fundoskopischen Untersuchung gestellt und kann ggf. mittels optischer Kohärenztomograhie (OCT) bestätigt werden. In diesem Beitrag wird Ihnen ein beispielhafter Fall einer sub-Membrana limitans interna (ILM)/subhyaloidalen Blutung vorgestellt, die verschiedenen Behandlungsmöglichkeiten werden dargelegt, und ein Überblick zum Einsatz des Nd:YAG-Lasers zur Lasermembranotomie als wenig invasive Therapieoption mit geringem Komplikationsprofil wird gegeben.

Schlüsselwörter

Nd:YAG-Laser Lasermembranotomie Prämakuläre Blutung Valsalva-Manöver Retinales Makroaneurysma 

Laser membranotomy in the management of acute premacular hemorrhage

Case report and overview on the approach

Abstract

Acute premacular bleeding is often associated with vasoproliferative retinal changes, vascular anomalies or a Valsalva maneuver. The diagnosis is made during the funduscopic examination and can if necessary be confirmed with optical coherence tomography (OCT). This article presents a case example with a sub-inner limiting membrane (ILM)/sub-hyaloidal bleeding. Furthermore, we present various treatment options and give an overview on the use of the Nd:YAG laser for laser membranotomy as a minimally invasive treatment option with a low complication profile.

Keywords

Nd:YAG Laser Laser membranotomy Premacular bleeding Valsalva maneuver Retinal macroaneurysm 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Roth, L. Eisenkopf, D. Engineer und J.C. Schmidt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

Literatur

  1. 1.
    Küper KDB, De Laey J‑J, Herzeel R (2002) Subhyaloid hemorrhage in association with an atypical central vein occlusion. Klin Monbl Augenheilkd 219(11):810–812.  https://doi.org/10.1055/s-2002-36321 CrossRefGoogle Scholar
  2. 2.
    Moorthy RS (2000) Dense premacular hemorrhage from a retinal macroaneurysm treated by argon laser. Retina 20(1):96–98 (http://www.ncbi.nlm.nih.gov/pubmed/10696757)CrossRefGoogle Scholar
  3. 3.
    Nayak J, Bhat PS, Acharya UR (2009) Automatic identification of diabetic maculopathy stages using fundus images. J Med Eng Technol 33(2):119–129.  https://doi.org/10.1080/03091900701349602 CrossRefGoogle Scholar
  4. 4.
    Lemmen KD, Helbig H (2008) Update diabetische Retinopathie und Makulopathie. Diabetologe 4(2):102–109.  https://doi.org/10.1007/s11428-008-0201-3 CrossRefGoogle Scholar
  5. 5.
    De Maeyer K, Van Ginderdeuren R, Postelmans L, Stalmans P, Van Calster J (2007) Sub-inner limiting membrane haemorrhage: causes and treatment with vitrectomy. Br J Ophthalmol 91:869–872CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Mansour AM, Salti HI, Han DP, Khoury A, Friedman SM, Salem Z et al (2000) Ocular findings in aplastic anemia. Ophthalmologica 214(6):399–402 (http://www.ncbi.nlm.nih.gov/pubmed/11053999)CrossRefGoogle Scholar
  7. 7.
    Prinzi RA, Saraf S, Desai A, Kuruvilla O, Desai UR (2015) Valsalva-like retinopathy secondary to pancytopenia following induction of etoposide and ifosfamide. Case Rep Ophthalmol Med.  https://doi.org/10.1155/2015/985303 (from: http://www.ncbi.nlm.nih.gov/pubmed/25694840)CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Konotey-Ahulu F (1997) Valsalva vitreous haemorrhage and retinopathy in sickle cell haemoglobin C disease. Lancet 349(9067):1774 (http://linkinghub.elsevier.com/retrieve/pii/S0140673605629960)CrossRefGoogle Scholar
  9. 9.
    Stoffelns B (2013) Spectral-domain optical coherence tomography (SD-OCT) in valsalva retinopathy with premacular hemorrhage treated by Nd:YAG laser membranotomy. Klin Monbl Augenheilkd 230:427–429CrossRefGoogle Scholar
  10. 10.
    Ladjimi A, Zaouali S, Messaoud R, Ben Yahia S, Attia S, Jenzri S et al (2017) Valsalva retinopathy induced by labour. Eur J Ophthalmol 12(4):336–338 (http://www.ncbi.nlm.nih.gov/pubmed/12220009)CrossRefGoogle Scholar
  11. 11.
    Georgiou T, Pearce IA, Taylor RH (1999) Valsalva retinopathy associated with blowing balloons. Eye (Lond) 13(Pt 5):686–687 (http://www.nature.com/doifinder/10.1038/eye.1999.193)CrossRefGoogle Scholar
  12. 12.
    Herr S, Pierce MC, Berger RP, Ford H, Pitetti RD (2004) Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis. Pediatrics 113(6):1658–1661 (http://www.ncbi.nlm.nih.gov/pubmed/15173487)CrossRefGoogle Scholar
  13. 13.
    Heichel J, Kuehn E, Eichhorst A, Hammer T, Winter I (2016) Nd:YAG laser hyaloidotomy for the treatment of acute subhyaloid hemorrhage: a comparison of two cases. Ophthalmol Ther 5(1):111–120.  https://doi.org/10.1007/s40123-015-0043-1 CrossRefGoogle Scholar
  14. 14.
    Duane TD (1973) Valsalva hemorrhagic retinopathy. Am J Ophthalmol 75(4):637–642 (http://www.ncbi.nlm.nih.gov/pubmed/4696667)CrossRefGoogle Scholar
  15. 15.
    Jain BK, Talbot EM (1994) Bungee jumping and intraocular haemorrhage. Br J Ophthalmol 78(3):236–237CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Chandra P, Azad R, Pal N, Sharma Y, Chhabra MS (2005) Valsalva and Purtscher’s retinopathy with optic neuropathy in compressive thoracic injury. Eye 19(8):914–915CrossRefGoogle Scholar
  17. 17.
    Meyer CH, Mennel S, Rodrigues EB, Schmidt JC (2006) Persistent premacular cavity after membranotomy in valsalva retinopathy evident by optical coherence tomography. Retina 26(1):116–118 (http://www.ncbi.nlm.nih.gov/pubmed/16395154)CrossRefGoogle Scholar
  18. 18.
    Foos RY (1972) Vitreoretinal juncture; topographical variations. Invest Ophthalmol 11(10):801–808 (http://www.ncbi.nlm.nih.gov/pubmed/4561129)Google Scholar
  19. 19.
    Sebag J (1992) Anatomy and pathology of the vitreo-retinal interface. Eye (Lond) 6(Pt 6):541–552 (http://www.nature.com/doifinder/10.1038/eye.1992.119)CrossRefGoogle Scholar
  20. 20.
    Stempels N, Tassignon MJ, Worst J (1990) Hemorrhage in the premacular bursa treated with the Q‑switched Nd-YAG laser. Ophtalmologie 4(3):314–316 (http://www.ncbi.nlm.nih.gov/pubmed/2250970)Google Scholar
  21. 21.
    Durukan AH, Kerimoglu H, Erdurman C, Demirel A, Karagul S (2008) Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy. Eye (Lond) 22(2):214–218 (http://www.ncbi.nlm.nih.gov/pubmed/16946748)CrossRefGoogle Scholar
  22. 22.
    Kwok AKH, Lai TYY, Chan NR (2003) Epiretinal membrane formation with internal limiting membrane wrinkling after Nd:YAG laser membranotomy in valsalva retinopathy. Am J Ophthalmol 136(4):763–766 (http://www.ncbi.nlm.nih.gov/pubmed/14516831)CrossRefGoogle Scholar
  23. 23.
    Gabel VP, Birngruber R, Gunther-Koszka H, Puliafito CA (1989) Nd:YAG laser photodisruption of hemorrhagic detachment of the internal limiting membrane. Am J Ophthalmol 107(1):33–37 (from: http://www.ncbi.nlm.nih.gov/pubmed/2912113)CrossRefGoogle Scholar
  24. 24.
    Gass J (1997) Stereoscopic atlas of macular diseases: diagnosis and treatment. In: Stereoscopic atlas of macular diseases: diagnosis and treatment, 3. Aufl. Mosby, St LouisGoogle Scholar
  25. 25.
    Mathew DJ, Sarma SK (2016) Valsalva retinopathy with double ring sign: laser membranotomy for twin bleeds. Saudi J Ophthalmol 30(1):68–70.  https://doi.org/10.1016/j.sjopt.2015.10.003 CrossRefGoogle Scholar
  26. 26.
    Srinivasan S, Kyle G (2006) Subinternal limiting membrane and subhyaloid haemorrhage in Terson syndrome: the macular “double ring” sign. Eye (Lond) 20(9):1099–1101.  https://doi.org/10.1038/sj.eye.6702134 CrossRefGoogle Scholar
  27. 27.
    Mennel S (2007) Subhyaloidal and macular haemorrhage: localisation and treatment strategies. Br J Ophthalmol 91(7):850–852CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Shukla D, Naresh KB, Kim R (2005) Optical coherence tomography findings in valsalva retinopathy. Am J Ophthalmol 140(1):134–136 (Available from: http://linkinghub.elsevier.com/retrieve/pii/S0002939404015132)CrossRefGoogle Scholar
  29. 29.
    Blaise P, Duchateau E, Comhaire Y, Rakic J‑M (2006) Optical coherence tomography in the diagnosis of premacular hemorrhage. Retina 26(2):232–234 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/16467688)CrossRefGoogle Scholar
  30. 30.
    García Fernández M, Navarro JC, Castaño CG (2012) Long-term evolution of Valsalva retinopathy: a case series. J Med Case Rep 6(1):346.  https://doi.org/10.1186/1752-1947-6-346 CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Cleary PE, Kohner EM, Hamilton AM, Bird AC (1975) Retinal macroaneurysms. Br J Ophthalmol 59(7):355–361 (http://www.ncbi.nlm.nih.gov/pubmed/1191622)CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Ramsay RC, Knobloch WH, Cantrill HL (1986) Timing of vitrectomy for active proliferative diabetic retinopathy. Ophthalmology 93(3):283–289 (http://www.ncbi.nlm.nih.gov/pubmed/3703496)CrossRefGoogle Scholar
  33. 33.
    O’Hanley GP, Canny CL (1985) Diabetic dense premacular hemorrhage. A possible indication for prompt vitrectomy. Ophthalmology 92(4):507–511 (http://www.ncbi.nlm.nih.gov/pubmed/2582330)CrossRefGoogle Scholar
  34. 34.
    Morris R, Kuhn F, Witherspoon CD, Mester V, Dooner J (1997) Hemorrhagic macular cysts in Terson’s syndrome and its implications for macular surgery. Dev Ophthalmol 29:44–54 (http://www.ncbi.nlm.nih.gov/pubmed/9413693)CrossRefGoogle Scholar
  35. 35.
    Schmidt J, Nietgen G (1999) Argon- oder YAG-Laser-Koagulation der hinteren Glaskorpergrenzschicht bei subhyaloidalen Blutungen. Lasermedizin 14(4):94–98.  https://doi.org/10.1016/S0938-765X(99)80014-5 CrossRefGoogle Scholar
  36. 36.
    Kroll P, Busse H (1986) Zur Therapie präretinaler Makulablutungen. Klin Monbl Augenheilkd 188(6):610–612 (http://www.ncbi.nlm.nih.gov/pubmed/3761966)CrossRefGoogle Scholar
  37. 37.
    Fechner PU (1980) Prämakulare Blutung, Eine Neue Indikation für den Argon-Laser. Klin Monbl Augenheilkd 177:502–505CrossRefGoogle Scholar
  38. 38.
    Emre S, Doganay S, Demirel S, Tasar A (2010) A new technique: argon green laser-Nd:YAG laser combination for the treatment of premacular haemorrhage. Acta Ophthalmol 88(3):94–95CrossRefGoogle Scholar
  39. 39.
    Krohn J, Bjune C (2004) Nd:YAG laser membranotomy for premacular haemorrhage. Acta Ophthalmol Scand 82:485–486CrossRefGoogle Scholar
  40. 40.
    Rennie CA, Newman DK, Snead MP, Flanagan DW (2001) Nd:YAG laser treatment for premacular subhyaloid haemorrhage. Eye 15(Pt 4):519–524 (http://www.nature.com/doifinder/10.1038/eye.2001.166)CrossRefGoogle Scholar
  41. 41.
    Sahu DK, Namperumalsamy P, Kim R, Ravindran RD (1998) Argon laser treatment for premacular hemorrhage. Retina 18(1):79–82 (http://www.ncbi.nlm.nih.gov/pubmed/9502290)CrossRefGoogle Scholar
  42. 42.
    Puliafito CA, Wasson PJ, Steinert RF, Gragoudas ES (1984) Neodymium-YAG laser surgery on experimental vitreous membranes. Arch Ophthalmol 102(6):843–847 (http://www.ncbi.nlm.nih.gov/pubmed/6547328)CrossRefGoogle Scholar
  43. 43.
    Raymond LA (1995) Neodymium:YAG laser treatment for hemorrhages under the internal limiting membrane and posterior hyaloid face in the macula. Ophthalmology 102(3):406–411 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7891977)CrossRefGoogle Scholar
  44. 44.
    Tassignon MJ, Stempels N, Van Mulders L (1989) Retrohyaloid premacular hemorrhage treated by Q‑switched Nd-YAG laser. A case report. Graefes Arch Clin Exp Ophthalmol 227(5):440–442 (http://www.ncbi.nlm.nih.gov/pubmed/2806930)CrossRefGoogle Scholar
  45. 45.
    Puthalath S, Chirayath A, Shermila MV, Sunil MS, Ramakrishnan R (2003) Frequency-doubled Nd:YAG laser treatment for premacular hemorrhage. Ophthalmic Surg Lasers Imaging 34(4):284–290 (http://www.ncbi.nlm.nih.gov/pubmed/12875456)Google Scholar
  46. 46.
    Ulbig MW, Mangouritsas G, Rothbacher HH, Hamilton AM, McHugh JD (1998) Long-term results after drainage of premacular subhyaloid hemorrhage into the vitreous with a pulsed Nd:YAG laser. Arch Ophthalmol 116(11):1465–1469 (http://archopht.jamanetwork.com/article.aspx?doi=10.1001/archopht.116.11.1465)CrossRefGoogle Scholar
  47. 47.
    Kuruvilla O, Munie M, Shah M, Desai U, Miller JA, Ober MD (2014) Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy. Saudi J Ophthalmol 28(2):145–151.  https://doi.org/10.1016/j.sjopt.2014.02.006 CrossRefPubMedCentralGoogle Scholar
  48. 48.
    Khadka D, Bhandari S, Bajimaya S, Thapa R, Paudyal G, Pradhan E (2016) Nd:YAG laser hyaloidotomy in the management of premacular subhyaloid hemorrhage. Bmc Ophthalmol 16(1):41 (http://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-016-0218-0)CrossRefPubMedCentralGoogle Scholar
  49. 49.
    Sabella P, Bottoni F, Staurenghi G (2010) Spectral-domain OCT evaluation of Nd:YAG laser treatment for Valsalva retinopathy. Graefes Arch Clin Exp Ophthalmol 248(4):599–601CrossRefGoogle Scholar
  50. 50.
    Khan MT, Saeed MU, Shehzad MS, Qazi ZA (2008) Nd:YAG laser treatment for Valsalva premacular hemorrhages: 6 month follow up: alternative management options for preretinal premacular hemorrhages in Valsalva retinopathy. Int Ophthalmol 28(5):325–327 (http://www.ncbi.nlm.nih.gov/pubmed/17891339)CrossRefGoogle Scholar
  51. 51.
    Mansour AM, Ojeimi GK (2017) Premacular subhyaloid hemorrhage following laser in situ keratomileusis. J Refract Surg 16(3):371–372 (http://www.ncbi.nlm.nih.gov/pubmed/10832989)Google Scholar
  52. 52.
    Cheung CMG, Benson MT (2003) Post-chemotherapy premacular subhyaloid haemorrhage. Eye (Lond) 17(1):97–99 (http://www.nature.com/doifinder/10.1038/sj.eye.6700273)CrossRefGoogle Scholar
  53. 53.
    Khadka D, Sharma AK, Shrestha JK, Pant B, Pant S, Shrestha A (2012) Nd:Yag laser treatment for sub-hyaloid hemorrhage in childhood acute leukemia. Nepal J Ophthalmol 4(1):102–107 (http://www.nepjol.info/index.php/NEPJOPH/article/view/5860)Google Scholar
  54. 54.
    Völcker D, Junker B, Hansen L (2012) Spontane Makulablutung. Ophthalmologe 109(7):702–706 (http://link.springer.com/10.1007/s00347-012-2539-6)CrossRefGoogle Scholar
  55. 55.
    Cleary PE, Kohner EM, Hamilton AM, Bird AC (1975) Retinal macroaneurysms. Br J Ophthalmol 59(7):355–361 (http://www.ncbi.nlm.nih.gov/pubmed/1191622)CrossRefPubMedCentralGoogle Scholar
  56. 56.
    Nadel AJ, Gupta KK (1976) Macroaneurysms of the retinal arteries. Arch Ophthalmol 94(7):1092–1096 (http://www.ncbi.nlm.nih.gov/pubmed/938290)CrossRefGoogle Scholar
  57. 57.
    Abdel-Khalek MN, Richardson J (1986) Retinal macroaneurysm: natural history and guidelines for treatment. Br J Ophthalmol 70(1):2–11 (http://www.ncbi.nlm.nih.gov/pubmed/3947596)CrossRefPubMedCentralGoogle Scholar
  58. 58.
    Dhindsa HS, Abboud EB (2002) Familial retinal arterial macroaneurysms. Retina 22(5):607–615 (http://www.ncbi.nlm.nih.gov/pubmed/12441727)CrossRefGoogle Scholar
  59. 59.
    Bopp S, Joussen A (2014) Retinale arterielle Makroaneurysmen (RAM) – Pathologie, Differenzialdiagnose und Therapie. Klin Monbl Augenheilkd 231:890–900.  https://doi.org/10.1055/s-0034-1382953 CrossRefGoogle Scholar
  60. 60.
    Chow CC, Mieler WF, Mittra RA, Pollack JS (2013) Retinal arterial macroaneurysms. In: Yanoff M, Duker JS (Hrsg) Ophthalmology, 4. Aufl. Elsevier Saunders, Oxford, S 575–579eGoogle Scholar
  61. 61.
    Conway MD, Peyman GA, Recasens M (1999) Intravitreal tPA and SF6 promote clearing of premacular subhyaloid hemorrhages in shaken and battered baby syndrome. Ophthalmic Surg Lasers 30(6):435–441 (http://www.ncbi.nlm.nih.gov/pubmed/10392730)Google Scholar
  62. 62.
    Chou Y‑K, Huang Y‑M, Lin P‑K (2015) Sub-internal limiting membrane hemorrhage treated with intravitreal tissue plasminogen activator followed by octafluoropropane gas injection. Taiwan J Ophthalmol 5(4):198–201 (http://linkinghub.elsevier.com/retrieve/pii/S2211505614000921)CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • M. Roth
    • 1
    • 2
  • L. Eisenkopf
    • 1
  • D. Engineer
    • 1
  • J. C. Schmidt
    • 1
    • 3
  1. 1.Augenklinik TausendfensterhausDuisburg-RuhrortDeutschland
  2. 2.Klinik für AugenheilkundeUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  3. 3.Klinik für AugenheilkundeUniversitätsklinikum MarburgMarburgDeutschland

Personalised recommendations