Iatrogenic parafoveal macular hole following Nd-YAG posterior hyaloidotomy for premacular haemorrhage

Abstract

Premacular sub-internal limiting membrane (sub-ILM) haemorrhage is a known cause of sudden profound loss of vision. Neodymium-doped yttrium aluminium garnet (ND-YAG) posterior hyaloidotomy is an inexpensive, effective and safe treatment modality for rapid drainage of haemorrhage covering the macula. An 18-year-old male patient presented to us with a history of Nd-YAG posterior hyaloidotomy for Valsalva-related premacular bleed. At the posterior pole, a cavity formed by the detached ILM with a central defect in ILM-posterior hyaloid complex was evident. High-definition optical coherence tomography (HD-OCT) showed normal foveal contour with a parafoveal macular hole. Hence, good clinical judgement, appropriate positioning of hyaloidotomy and use of lowest possible energy level is the key to a successful and safe laser drainage of a premacular haemorrhage.