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Preretinal haemorrhages usually occur at the interface between the posterior hyaloid and inner limiting membrane (ILM). Less frequently, they are located in the superficial retina between the ILM and the retinal nerve fibre layer. 1- 3 These sharply demarcated, dome-shaped haemorrhages show a predilection for the macular region and consequently lead to severe visual impairment.
Sub-ILM haemorrhages have been associated with various different causes, the most common being Valsalva retinopathy 4 and Terson's syndrome. 5 However, the sub-ILM nature of the haemorrhage remains difficult to distinguish clinically. We report on five cases in which the sub-ILM location of the premacular haemorrhage was confirmed during pars plana vitrectomy. Independent of the underlying causes, excellent visual recovery was obtained by vitrectomy with ILM peeling and aspiration of the haemorrhage.
CASE REPORTS
Case 1
A 42-year-old woman was referred with bilateral vitreous haemorrhage as a result of Terson's syndrome after subarachnoidal haemorrhage. Vision improved spontaneously from bilateral light perception to 20/50 OD and 20/200 OS after 4 months. As there was no further improvement, vitrectomy was performed in the left eye, during which a sub-ILM haemorrhage became apparent. An ILM peeling was performed with complete evacuation of the haemorrhage. A vitrectomy of the right eye, performed 3 months later, revealed a similar sub-ILM haemorrhage and was treated correspondingly. Both procedures were successful with postoperative vision of 20/20 OU.
Case 2
A 20-year-old student presented to the emergency room with impaired vision of the left eye after repeated stress-related vomiting. Funduscopic examination revealed two intraretinal haemorrhages, the largest being situated premacularly (fig 1). After exclusion of other causes, a tentative diagnosis of Valsalva retinopathy was made. Considering the premacular location of the haemorrhage without spontaneous resorption after 2 weeks, we decided to perform a vitrectomy. Infracyanine green staining 6 revealed the sub-ILM location of both haemorrhages, which were subsequently evacuated. Vision improved from hand movements preoperatively to 20/20 after vitrectomy.
Fundus photograph of the left eye (case 2) showing a large premacular sub-inner limiting membrane haemorrhage.
Case 3
A 24-year-old construction worker was referred with a vitreous and premacular haemorrhage of the right eye. A sub-ILM haemorrhage was diagnosed during vitrectomy, performed 6 weeks later. Vision improved from hand movements preoperatively to 20/20 after surgery. History revealed repetitive...