Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case report
Abstract Background Accurate localization of premacular hemorrhages (PMHs) is crucial as treatment strategies vary significantly based on whether the hemorrhage resides within the vitreous gel, subhyaloid space, or beneath the internal limiting membrane (ILM). This report outlines the clinical featu...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12886-024-03842-7 |
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| author | B. R. Smitha Naman Sahni Priyanka Gandhi Rupal Kathare Vishma Prabhu Prathiba Hande Jay Chhablani Ramesh Venkatesh |
| author_facet | B. R. Smitha Naman Sahni Priyanka Gandhi Rupal Kathare Vishma Prabhu Prathiba Hande Jay Chhablani Ramesh Venkatesh |
| author_sort | B. R. Smitha |
| collection | DOAJ |
| description | Abstract Background Accurate localization of premacular hemorrhages (PMHs) is crucial as treatment strategies vary significantly based on whether the hemorrhage resides within the vitreous gel, subhyaloid space, or beneath the internal limiting membrane (ILM). This report outlines the clinical features, diagnostic findings, and treatment outcomes in a patient diagnosed with a PMH secondary to suspected Valsalva retinopathy. Methods This is a retrospective interventional case report. Results A 43-year-old healthy male presented with sudden vision loss in his left eye, reporting a visual acuity of 6/120 since the previous evening. Fundus examination revealed a PMH characterized by a “double-ring sign” accompanied by diffuse retinal hemorrhages. Optical coherence tomography confirmed that the hemorrhage was located in the sub-ILM space. The patient underwent two sessions of YAG laser membranotomy, utilizing energies of 2.5 mJ and 5 mJ, which successfully facilitated drainage of fresh hemorrhage from the sub-ILM space to the subhyaloid space and vitreous cavity. However, the presence of residual coagulated blood over the fovea resulted in persistent visual impairment, necessitating a subsequent pars plana vitrectomy (PPV). The PPV, in conjunction with internal limiting membrane peeling, effectively removed the remaining blood in front of the fovea and restored the visual acuity. By postoperative day 3, the patient experienced a significant improvement in visual acuity, measuring 6/8. Conclusion This case underscores the importance of thorough clinical examination and precise diagnostic techniques in the individualized management of PMHs, which is essential for achieving optimal visual outcomes. |
| format | Article |
| id | doaj-art-200f5f64d80a4e9d9b7ef3d906c0de5d |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Ophthalmology |
| spelling | doaj-art-200f5f64d80a4e9d9b7ef3d906c0de5d2025-01-05T12:11:51ZengBMCBMC Ophthalmology1471-24152025-01-012511610.1186/s12886-024-03842-7Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case reportB. R. Smitha0Naman Sahni1Priyanka Gandhi2Rupal Kathare3Vishma Prabhu4Prathiba Hande5Jay Chhablani6Ramesh Venkatesh7Department of Retina and VitreousDepartment of Retina and VitreousDepartment of Retina and VitreousDepartment of Retina and VitreousDepartment of Retina and VitreousDepartment of Retina and VitreousUniversity of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal SurgeryDepartment of Retina and VitreousAbstract Background Accurate localization of premacular hemorrhages (PMHs) is crucial as treatment strategies vary significantly based on whether the hemorrhage resides within the vitreous gel, subhyaloid space, or beneath the internal limiting membrane (ILM). This report outlines the clinical features, diagnostic findings, and treatment outcomes in a patient diagnosed with a PMH secondary to suspected Valsalva retinopathy. Methods This is a retrospective interventional case report. Results A 43-year-old healthy male presented with sudden vision loss in his left eye, reporting a visual acuity of 6/120 since the previous evening. Fundus examination revealed a PMH characterized by a “double-ring sign” accompanied by diffuse retinal hemorrhages. Optical coherence tomography confirmed that the hemorrhage was located in the sub-ILM space. The patient underwent two sessions of YAG laser membranotomy, utilizing energies of 2.5 mJ and 5 mJ, which successfully facilitated drainage of fresh hemorrhage from the sub-ILM space to the subhyaloid space and vitreous cavity. However, the presence of residual coagulated blood over the fovea resulted in persistent visual impairment, necessitating a subsequent pars plana vitrectomy (PPV). The PPV, in conjunction with internal limiting membrane peeling, effectively removed the remaining blood in front of the fovea and restored the visual acuity. By postoperative day 3, the patient experienced a significant improvement in visual acuity, measuring 6/8. Conclusion This case underscores the importance of thorough clinical examination and precise diagnostic techniques in the individualized management of PMHs, which is essential for achieving optimal visual outcomes.https://doi.org/10.1186/s12886-024-03842-7Yag laser membranotomyOutcomesub-ILM hemorrhageValsalva retinopathyVitrectomy |
| spellingShingle | B. R. Smitha Naman Sahni Priyanka Gandhi Rupal Kathare Vishma Prabhu Prathiba Hande Jay Chhablani Ramesh Venkatesh Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case report BMC Ophthalmology Yag laser membranotomy Outcome sub-ILM hemorrhage Valsalva retinopathy Vitrectomy |
| title | Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case report |
| title_full | Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case report |
| title_fullStr | Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case report |
| title_full_unstemmed | Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case report |
| title_short | Multifaceted approach to evacuating multi-level premacular hemorrhage in a case of suspected Valsalva retinopathy – a case report |
| title_sort | multifaceted approach to evacuating multi level premacular hemorrhage in a case of suspected valsalva retinopathy a case report |
| topic | Yag laser membranotomy Outcome sub-ILM hemorrhage Valsalva retinopathy Vitrectomy |
| url | https://doi.org/10.1186/s12886-024-03842-7 |
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