Título

SUB-INTERNAL LIMITING MEMBRANE HEMORRHAGE: SURGICAL TREATMENT

Introdução / Purpose

To report a case of Valsalva retinopathy and sub inner limitant membrane (sub-ILM) hemorrhage that was successfully treated with combined pars plana vitrectomy with ILM peeling and phaco with intraocular (IOL) implantation

Material e Método / Methods

A 53-year old female with clinical history of systemic hypertension was referred to our clinic with sudden and painless vision lost her left eye for two weeks. At presentation, best corrected visual acuity was 20/25 in OD and count fingers at 6 inches in OS; intraocular pressure was normal in both eyes; biomicroscopy revealed incipient senile cataract in both eyes; fundoscopy was normal in OD and showed a macular hemorrhage in OS. Fundus photography, fluoresceinic angiography and optical coherence tomography (OCT) respectively exhibited a well-circumscribed macular hemorrhage upon the fovea, hypofluoresecence due to blockage and a domeshaped hyporeflective area compatible with sub-ILM hemorrhage.

Resultados / Results

After one month observation and no evidences of improvement, combined pars plana vitrectomy with ILM peeling and phaco with IOL implantation was performed. Post operative visual acuity at 1 month was 20/200 in OS, OCT showed cystoid macular edema and angiography revealed perifoveal capillary leakage and a normal optic disc. The edema was attributed to inflammation related to surgical manipulation and treated with topical corticosteroids. At 3 months after surgery, best corrected visual acuity was 20/30 in OS and OCT showed discrete irregularities in the retinal layers and complete resolution of the edema.

Discussão e Conclusões / Discussion

In this case, vitrectomy with ILM peeling and phaco with IOL implantation had an excellent result, allowing significant improvement of visual acuity. The surgical treatment can be a safe and effective alternative to observation and laser treatment, offering rapid visual recovery and reducing complications related to the prolonged presence of intraocular hemorrhage as toxic retinal damage and epiretinal membrane

Palavras Chave

Valsalva retinopathy, Retinal Hemorrhage, Vitrectomy