Nd: YAG laser hyaloidotomi in the treatment of premacular subhyaloid hemoragia

AIM: To evaluate the efficacy and safety of Nd:YAG laser hyaloidotomy in the treatment of premacular subhyaloid hemorrhage (SHH). MATERIALS AND METHODS: The files of 37 patients who consulted to our retina department between 2014 and 2022 and underwent Nd:YAG hyaloidotomy due to premacular SHH were reviewed retrospectively. The patients were evaluated in terms of age, gender, etiology, duration of symptoms, visual acuity, amount of laser energy, number of shots, complications and need for additional procedures. Visual acuities were noted at admission, on the 1st day, 1st week, 1st month, 3rd month and 6th month after the procedure. The main evaluation criteria for the success of the procedure were drainage and resorption of SHH into the vitreous, increased visual acuity, need for additional procedures, and post-procedural complications. RESULTS: There were 39 eyes of 37 patients, 19 (51.35%) male and 18 (48.65%) female. Mean age was 52.03 ± 20.51 years, mean symptom duration was 10.51 ± 7.43 days. Etiologically, the most common proliferative diabetic retinopathy (PDRP) (n:13), retinal vein occlusion (n:6), valsalva retinopathy (n:5), leukemia (n:5), macroaneurysm (n:2), hypertensive crisis, (n:2), choroidal neovascular membrane (n:2), Terson syndrome (n:2) respectively. The average laser energy applied was 7.38± 2.08 mJ (minimum 5, maximum 12 mJ), the average number of shots was 4.28± 1.87. Nd:YAG laser hyaloidotomy was successful in 34 eyes (87.17%). The procedure failed 5 eyes and pars plana vitrectomy was required. Visual acuity increased from a mean of 2.89±0.49 logMAR before the procedure to an average of 0.34±0.37 logMAR at 6 months (p<0.001). CONCLUSION: Nd:YAG laser hyaloidotomy is an cheap, effective, safe and non-invasive treatment for premacular SHH. It provides avoidance of invasive vitreoretinal surgery and its complications. Visual prognosis depends on the etiology of SHH and accompanying macular changes. Keywords: Subhyaloid, hemorrhage, YAG, laser, hyaloidotomy, surgery