Nd:YAG Posterior Hyaloidotomy
Overview
A technique using Nd:YAG laser to create an opening in the posterior hyaloid face, releasing trapped premacular (subhyaloid) hemorrhage into the vitreous cavity. This allows the blood to disperse and clear more rapidly than if left to resorb in place.
Mechanism / How It Works
- Nd:YAG laser is focused on the inferior edge of the premacular hemorrhage (to allow gravity-dependent drainage)
- The laser disrupts the posterior hyaloid membrane
- Trapped blood drains into the vitreous cavity where it is absorbed more quickly
- Visual recovery depends on duration of macular contact with the hemorrhage
Indications & Contraindications
- Indicated: Premacular (subhyaloid) hemorrhage â from RAM, Valsalva retinopathy, PDR, Terson syndrome
- Not for submacular hemorrhage â that requires pneumatic-displacement
- Details on contraindications to be expanded â risk of retinal damage from laser, potential macular hole
In the RAM Context
From the RAM source: premacular hemorrhage from ruptured hemorrhagic retinal-arterial-macroaneurysm can be released into the vitreous using Nd:YAG hyaloidotomy for faster clearance.
Related
- retinal-arterial-macroaneurysm â cause of premacular hemorrhage
- pneumatic-displacement â alternative for submacular (not premacular) hemorrhage
- vitreous-hemorrhage â consequence of the procedure (intentional)
Sources
- macroaneurysm-eyewiki (brief mention in RAM management)
Gap: Needs dedicated source on technique details, outcomes, complications, and comparison with observation.