[Hemorrhage in the premacular bursa treated with the Q-switched Nd-YAG laser]

Hemorrhages in the premacular bursa may cause an important loss of the visual acuity due to their localization. Several treatments, going from a conservative attitude to prompt vitrectomy, have been proposed. Three cases of premacular hemorrhage, treated by Nd-YAG laser puncture, are reported. One or two impacts are sufficient to empty the blood collection into another vitreous compartment. The blood is dispersed through the vitreous on the second day after treatment and is resorbed within the ten to fifteen following days. With the help of ultrasound, the blood volume was estimated to be equal to or less than 10 microliters in the three cases. In all cases the YAG laser puncture allows a faster recovery of the visual acuity as compared to the conservatively treated cases. In no instance a recurrence, macular degeneration or preretinal proliferation was observed. The new concepts of vitreo-macular relations and vitreous anatomy are well illustrated by this therapeutic indication. Although the precise localization of a blood collection in the premacular area remains controversial, we consider it of no consequence to the outcome of the treatment.