First Author: I.Malov RUSSIA
Co Author(s): N. Strenev
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To present a clinical case of a bilateral premacular haemorrhage in a patient with acute myeloblastic leukemia treated with YAG laser puncture in both eyes with different location of puncture point.
IRTC Eye Microsurgery Ekaterinburg centre, Ekaterinburg, Russia
A 23-years old patient addressed complaining for acute bilateral visual acuity drop in both eyes 6 weeks before; at the same time, acute myeloblastic leukemia was diagnosed, the patient received a block of polychemotherapy. BCVA was 0.1 in the right eye, 0.05 in the left eye. Large premacular haemorrhages in both eyes (5 disc diameters in the right eye and 3 disc diameters in the left eye). Laser puncture of the inner walls of the haemorrhages was performed in one session on both eyes with VisuLas YAG III laser (Carl Zeiss Meditec, Germany). Two pulses, Е = 2 mJ were performed on each eye. In the right eye, puncture was performed traditionally at the lower edge of the haemorrhage. In the left eye, lower edge of the haemorrhage was in the fovea, and puncture point was chosen above the fovea. During follow-up the patient received three blocks of polychemotherapy.
One week after puncture, BCVA has increased to 0.7 in the right eye and 0.08 in the left eye. Residual haemorrhages were seen in both eyes. Five weeks after puncture: BCVA 0.7 in the right eye, 0.1 in the left eye. Complete haemorrhage resorption in the right eye and small residual haemorrhage in the left eye. Fourteen weeks after puncture, BCVA was 1.0 in the right eye, 0.6 in the left eye. Small blood remnants were marked in the left fovea. OCT revealed almost complete resorption of highly reflective inclusions in front of fovea in both eyes. Final visit of the patient was 26 weeks after treatment; complete resorption of haemorrhages in both eyes on fundus photo and OCT. Visual acuity in both eyes did not change.
Premacular haemorrhages treatment with YAG laser is effective and safe, including patients with severe somatic pathology. The presented case shows the possibility of treatment in case of lower haemorrhage edge location in the fovea, placing the puncture point above the fovea. In this case blood resorption is slower than with location of puncture point at the lower edge of the haemorrhage.