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Unknown bleed in the eye saved in time-Pre- Macular Sub Hyaloid hemorrhage

34 year old healthy male came with chief complaints of sudden diminution of vision in Left eye since 1 day. He has no history of any injury or any systemic illness. On examination his best corrected visual acuity for Right eye was 6/6 but that of left was N6 i.e. counting finger close to face. On conusltation with Dr. Yogesh Patil, Retina and Vitreous Specialist; the anterior segment examination was normal for both the eyes. Dr. Yogesh Patil carried out fundus examination and found out that the right eye was normal but the left eye showed large "PRE MACULAR SUB-HYALOID HEMORRHAGE".

Pre- Macular Sub Hyaloid hemorrhage is a bleed in a previously non existing space between the vitreous ( a stagnant fluid filled space between the lens and the retina) and the retina ( back of the eye ball that contains the area that is responsible for vision and has sensitive cells for vision). 

 

(Right eye)   

 

 (Left eye)

 

The patient underwent OCT (Optical coherence tomograph) for left eye and fundus fluoresceine angiography ( Dye that is inserted through the hands that helps in observing the eye blood vessels) to rule out any sub-retinal involvement, which was not there. Then he underwent Argon laser hyalidotomy to release sub-hyaloid bleed into vitreous cavity. 

 

      On Day 1 (Left eye) the visual improved from finger counting to 6/24,N12 due to clearance of hemorrhage from foveal area. 

 

(Left eye Day 1 after procedure)    

 

At Day 2 (Left eye) the vision decreased to Finger counting again due to dispersed vitreous hemorrhage whcih was explained to the patient. The dispersed vitreous hemorrhage would heal slowly and gradually.

 

(Left eye Day 2 after procedure)

 

 (Left eye Day 5 after procedure) 

 

Subsequently he was advised to keep his head in an elevated posture and to avoid straining. He was advised to review weekly.At the end of 3 months after primary laser procedure patient is absolutely normal with a vision of of 6/6 and N6 ( normal vision).

 

(Left eye 3 months after procedure)

 

This patient recovered full vision without surgical procedure because of early intervention.

 

Take home message

Never ignore any symptoms related to the eye as an early treatment can save from a disability later.

 

About Dr. Yogesh Patil:

Dr. Yogesh Patil (MBBS, MS (Ophth), Fellow Vitreo-Retinal Surgery) is a Vitreo- Retinal Surgeon at Advanced Eye Hospital and Institute. He has achieved remarkable competence in the treatment of various diseases involving the retina, vitreous and macula as well as extensive training in the skills of various Vitreo-retinal surgeries.