Nd:YAG Membranotomy in Preretinal Hemorrhages
Hemorrhages in the macular area occur in some retinal diseases such as diabetic or hypertensive retinopathy and in Valsalva retinopathy in young and healthy individuals after acute increase of venous pressure. They are often called subhyaloidal hemorrhages while their ophthalmoscopical appearance with a glistening light reflex and some fine striae as well as histologic examination indicate that they lie beneath the inner limiting membrane (Gass 1968, Gass 1977). These lesions initially reduce the visual acuity dramatically and they tend to resolve spontaneously within some weeks leaving hemosiderin impregnation of the underlying retinal tissue resulting in a permanent reduction of visual acuity. In addition to the spontaneous course an alternative therapy would be vitrectomy which has benefits, but also the risk of an intraocular procedure. In the German literature there are reports of another alternative treatment consisting of opening the internal limiting membrane by means of thermal effects produced by Xenon arc — photocoagulators or argon lasers (Heidenreich 1973, Fechner 1980, Kroll 1986).
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