Premacular hemorrhages under the internal limiting membrane: laser vs vitreoretinal surgery

Purpose. To present the results of transpupillary YAG laser puncture of the internal limiting membrane and vitrectomy with local peeling of the internal limiting membrane in the treatment of premacular hemorrhages with blood accumulation between the nerve fiber layer and the internal limiting membrane. Material and methods. From 2021 to 2024, premacular hemorrhage under the internal limiting membrane was diagnosed in 10 patients at the Scientific and Technical Complex “Microsurgery of the Eye”. 7 patients underwent YAG laser puncture of the internal limiting membrane using the developed method (RU Patent for Invention No. 2831788, priority dated 11.06.2024). Three patients underwent vitrectomy with local peeling of the internal limiting membrane over the hemorrhage area. Visual acuity before treatment varied from correct light projection to 0.1. The observation period ranged from 6 to 36 months. Results. After YAG laser puncture, it was possible to achieve through perforation of the internal limiting membrane without damaging the deeper structures of the retina in all cases. Drainage of blood into the preretinal space occurred gradually over a period of up to two days after laser treatment. The foveolar profile in all patients was restored by the end of the first month with preservation of normal angioarchitecture. The best-corrected visual acuity (BCVA) in the observation period from 6 months to 3 years was 0.9 ± 0.08. After vitrectomy with local peeling of the internal limiting membrane, the BCVA during the observation period of 12 to 18 months was 0.67 ± 0.15. According to the SOCT data, in all cases, a smoothing of the foveal profile and a defect of the internal limiting membrane within the membrane peeling performed were noted. Conclusion. The proposed method of local YAG laser puncture of the internal limiting membrane in isolated premacular hemorrhage can be used as an alternative to vitreoretinal surgery, which will allow for the restoration of visual functions and the patient’s ability to work in an outpatient setting and in a short time. Keywords: transpupillary YAG laser puncture of the internal limiting membrane, vitrectomy with local peeling of the internal limiting membrane, premacular hemorrhages