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Background: Terson syndrome (TS) is a neuro-ophthalmologic disease arising due to subarachnoid hemorrhage (SAH), resulting in the formation of subhyaloid hemorrhagic spots. These spots can affect the ability to see due to the alteration of the optic cameras. Although it often affects both eyes, the symptoms and the eye involvement can be asymmetrical in rare cases. Case Description: We described the case of a 52-year-old female patient who developed Terson disease following the rupture of a right middle cerebral artery aneurysm occurring during coitus with SAH (Fisher grade III). The aneurysm was treated by endovascular coiling. Interestingly, despite the major involvement of the right eye, the patient primarily manifested symptoms of visual changes in the left eye. Conclusion: TS is a frequent ocular complication of SAH, with symptoms typically affecting both eyes. Characterized by hemorrhagic spots in both subhyaloid layers, the syndrome's symptomatology is generally bilateral. However, in the case described, the manifestation is deemed atypical, primarily appearing contralateral to the hemisphere exhibiting a greater pattern of SAH.

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Subhyaloid hemorrhage, characterized by localized vitreoretinal detachment due to blood accumulation, often results in sudden vision loss, especially in the macular area. This case report highlights a 23-year-old female presenting with exercise-related Valsalva retinopathy leading to premacular subhyaloid hemorrhage. The patient underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser hyaloidotomy, a non-invasive procedure, leading to rapid blood drainage and visual recovery. The patient's initial visual acuity was severely impaired, with a significant premacular hemorrhage obscuring the macula. A week later, due to the expanding hemorrhage, Nd:YAG laser hyaloidotomy was performed, demonstrating successful blood dispersion and restoration of vision. Follow-up revealed significant improvement with demarcation of the previous hemorrhage and no evidence of new findings. The case emphasizes the importance of prompt intervention and considers alternative treatments for premacular subhyaloid hemorrhage. While associated with ocular pathologies, such as macular holes and retinal detachment, Nd:YAG laser hyaloidotomy remains a safe and effective outpatient procedure for managing premacular subhyaloid hemorrhage, avoiding the risks of more invasive surgical interventions. The presented case highlights the significance of tailored interventions based on patient history, minimizing the need for invasive procedures and their associated risks.

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The authors report two cases of retinal artery macroaneurysm (RAM) complicated with subhyaloid hemorrhage. There are multiple cases about RAM that have been published; however, none of them present all the different treatments with its benefits and its limitations. Our study highlights all aspects of treatment. RAM is an uncommon pathology that affects generally elderly women with systemic vascular pathologies. It is often unilateral, and the patients stay mostly asymptomatic. Most cases of RAM regress without any treatment. A case of a 54-year-old male, with a medical history of hypertension who presented with an acute and unilateral decreased visual acuity (VA). Initial VA was limited to counting fingers at 1 m in the right eye (RE). The anterior segment was normal in both eyes. A fundus examination in the RE showed a large subhyaloid hemorrhage associated to retinal hemorrhage. Fluorescein angiography in the RE did not reveal any sign of macroaneurysm due to blockage of fluorescein by the hemorrhage. In the left eye, there was a hyperfluorescent paramacular lesion. Optical coherence tomography showed the hyperreflectivity of the subhyaloid hemorrhage and the underlying retinal layers could not be seen. Neodymium-doped yttrium aluminum garnet laser hyaloidotomy was performed for this patient to release the trapped hemorrhage into the vitreous, 3 weeks after initial loss of vision with a good visual outcome after the treatment. An 80-year-old woman, with medical history of rheumatoid arthritis who presented with an acute loss of vision in the RE. VA in the RE was 20/200. She had a nuclear cataract in both eyes. A fundus examination showed a subyaloid hemorrhage. Fluorescein angiography in the RE revealed a hyperfluorescent structure emanating from the superotemporal arcade of the artery compatible with a macroaneurysm. The patient was treated with three intravitreal antivascular endothelial growth factor injections with poor visual outcomes. Vision loss occurs with RAM complications. They mainly involve hemorrhages and macular exudations and are usually associated with poor visual recovery. There is no established treatment for RAM and its complications. There are many options, but the optimal therapy is still unknown.

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BACKGROUND: Ophthalmic manifestations are common in patients with leukemia, developing in nearly 50% of cases. Intracranial hemorrhage is another potentially fatal complication of leukemia. In this case report, we aim to present a challenging case that involves both ophthalmic and intracranial manifestations in an individual with acute monocytic leukemia. CASE PRESENTATION: A 36-year-old Persian male presented to the emergency room with complaints of fever, headache, and bilateral blurred vision. The patient had been diagnosed with acute monocytic leukemia 3 months prior and had undergone four sessions of induction chemotherapy, the last of which was 10 days prior to admission. The patient was admitted to the internal medicine service, and initial lab studies confirmed pancytopenia, including severe neutropenia, anemia, and thrombocytopenia. Subarachnoid hemorrhage in the left frontal lobe was detected through spiral brain computed tomography scan. Ophthalmic examination revealed visual acuity of light perception in the right eye and 3-m finger count in the left eye. Fundus examination revealed bilateral peripapillary subhyaloid and intraretinal hemorrhages, confirming leukemic retinopathy. The patient showed significant improvement in visual acuity and hemorrhage resolution through conservative treatment and regular follow-ups after 3 months. CONCLUSION: Simultaneous subarachnoid hemorrhage and bilateral subhyaloid hemorrhages seemed to have occurred as a result of pancytopenia. Management approach of ophthalmic manifestations of leukemia involves interdisciplinary cooperation and should be individualized on the basis of the patients' underlying medical condition.

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A 65-year-old male with proliferative diabetic retinopathy (PDR) and non-clearing vitreous hemorrhage underwent 25G pars plana vitrectomy (PPV). A large disk of thick organized blood of 5 disk diameter (DD) size was encountered in subhyaloid space. All attempts including lower cut rates to remove this disk using a 25G cutter turned futile. We used a 20G fragmatome to safely remove this hard clot from vitreous cavity in 50 s. Surgical time for removal of similar clot of 3 DD by 25G cutter in another eye was 5 min. Removal of thick clotted subhyaloid blood by ultrasonic fragmentation during diabetic vitrectomy is a safe, faster, and useful maneuver.

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BACKGROUND: To describe a unique case of decompression retinopathy manifesting as pre-macular subhyaloid hemorrhage that occurs in a nine-day old child after undergoing a non-penetrating deep sclerectomy for primary congenital glaucoma. CASE PRESENTATION: We report a single case of a 9-day-old boy who was referred to our department of ophthalmology for bilateral buphtalmia and corneal edema. He presented marked elevation of the intraocular pressure in both eyes (22 mmHg and 26 mmHg, in the right eye and left eye respectively) associated with significant optic nerve cupping. Non-penetrating deep sclerectomy was performed for each eye, with effective reduction of the intraocular pressure during the first week postoperatively (11 mmHg and 7 mmHg in the right eye and left eye respectively). The right eye presented an isolated subhyaloid hemorrhage located in the pre-macular area, persisting 3 weeks after the initial surgery and requiring pars-plana vitrectomy to clear the visual axis. This uncommon complication was identified as decompression retinopathy. The intraocular pressure remained controlled in the normal range three years after initial surgery in both eyes, with reversal of optic disc cupping. CONCLUSIONS: Decompression retinopathy is a potential complication after non-penetrating deep sclerectomy in primary congenital glaucoma, requiring prompt treatment strategy to prevent potential organic amblyopia.

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PURPOSE: To report a case of traumatic subhyaloid macular hemorrhage with severe sudden vision loss treated successfully with Neodymium-Doped Yttrium Aluminium Garnet Laser (Nd:YAG laser). OBSERVATIONS: A 16-year-old boy presented to the eye clinic with acute vision loss secondary to blunt trauma by a stone to his left eye 3 days prior to consultation that caused subhyaloid macular hemorrhage. Nd:YAG laser was performed to open the hyaloid membrane and allow the blood to diffuse into the vitreous cavity and be absorbed. The patient demonstrated complete recovery as his visual acuity went from counting fingers to 20/20 within 20 days. No complications due to the treatment were reported. CONCLUSIONS AND IMPORTANCE: To the best of our knowledge, there have been no reported cases of subhyaloid macular hemorrhage treated with Nd:YAG laser in which the etiology was trauma and showed full, rapid recovery with no sequelae.

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BACKGROUND: Premacular subhyaloid hemorrhage results in a sudden profound loss of vision. Among the modalities for its treatment, Nd:YAG laser hyaloidotomy is a non invasive method enabling rapid drainage of the obstructed macular area and improved vision within days. This study was aimed to evaluate the efficacy, visual outcome and complications following Nd:YAG laser hyaloidotomy for premacular subhyaloid hemorrhage. METHODS: Patients with premacular subhyaloid hemorrhage of more than 3 disc diameters (DD) of various etiologies, attending Tilganga Institute of Ophthalmology, Nepal from August, 2014 to February, 2015, were included. A comprehensive ocular evaluation was conducted and fundus photographs were taken to measure the size of the subhyaloid hemorrhage. Optical coherence tomography (OCT) were performed before and after treatment and on subsequent follow up visits. Fundus fluorescence angiography was done whenever necessary. Q switched Nd:YAG laser was applied to create an opening in the posterior hyaloids membrane for draining subhyaloid hemorrhage. The main outcome measures were success rate in performing hyaloidotomy, drainage of subhyaloid blood into vitreous cavity and its resorption, improvement in visual acuity, need for further intervention and postoperative complications. RESULTS: There were 21 eyes of 19 patients, 17(89.48%) male and 2(10.52%) female. In 3, premacular subhyaloid hemorrhage was bilateral. Mean age was 41.68 ± 17.08 years and a mean duration of symptoms 15.04 days. Mean pretreatment hemorrhage was 6.27DD. Nd:YAG laser hyaloidotomy was successful in 19 eyes(86.4%). In 2 patients, one each with Eales' disease and retinal vein occlusion the procedure was unsuccessful, necessitating pars plana vitrectomy, while in a case with proliferative diabetic retinopathy (PDR), vitrectomy was resorted for non clearing vitreous hemorrhage. Vision improved from a median of 3/60 pre-operatively to 6/6, at 6 months follow up. At 3 months, 2 patients with Eales' disease, one developed tractional detachment at macula while the other, an epiretinal membrane. No other complications were noted at 6 months. CONCLUSION: Nd:YAG laser hyaloidotomy is an inexpensive, effective and a safe outpatient procedure for premacular subhyaloid hemorrhage, producing rapid drainage with restoration of visual function avoiding more invasive procedures and enabling early assessment of the underlying retina. The final visual prognosis however, rests on the underlying cause of the subhyaloid hemorrhage and any accompanying retinal changes.

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Laser pointers are practical and safe training tools when used properly. If used incorrectly they can cause ocular damage, potentially resulting in devastating vision loss. The ocular and visual morbidity can result in significant expenses for medical care and inability to work (temporarily or permanently) for civilians and military personnel. We present three cases of soldiers who experienced vision loss following exposure to laser pointers, while celebrating successful football game.

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Subhyaloid hemorrhages can occur as a result of exposure to high altitude. We hereby report a clinical picture of subhyaloid hemorrhage associated with high altitude. The case demonstrates optical coherence tomography findings that aid diagnosis of subhyaloid hemorrhage.

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OBJECTIVE: To evaluate the efficacy, visual outcome and complication following Nd:Yag laser hyaloidtomy for subhyaloid hemorrhage. METHODS: This interventional case series was managed at LRBT, Free Base Eye Hospital Karachi from January 2010 to December 2010. It included 30 eyes of 30 patients with subhyaloid hemorrhage due to different causes which underwent Nd: Yag laser sublyaloidotomy Results: Out of thirty patients, eighteen (60%) were male and twelve (40%) were females. Mean age was 32.57 years. Males pre-dominated the study. Pre laser visual acuity was between counting finger at one meter in 22 patients (73.33%) and between counting finger one meter to hand movement in 8 patients (26.66%). Vision improved to 6/6 in 10 patients (33%), 6/9 - 6/12 in 17 patients (56.66%) and between 6/24 - 6/60 in 3 patients (9.99%) at the end of follow up. Complications were persistent vitreous hemorrhage in one (3.33%) patient, failed drainage in one (3.33%) patient and metamorphopsia in one (3.33%) patient. CONCLUSION: Nd: Yag laser hyloidotomy is an excellent technique for management of Subhyaloid hemorrhage with early visual recovery provided there is no macular pathology.

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A 45-year-old female with underlying idiopathic thrombocytopenic purpura (ITP) complained of acute onset of reduced vision and floaters, in both eyes, for 3 weeks. Visual acuity was 6/36 and 6/60 in the right eye and left eye, respectively. Ophthalmoscopy showed bilateral peripapillary, subhyaloid and vitreous hemorrhage. Hematological evaluation revealed moderate anemia (hemoglobin: 93 g/L) and mild thrombocytopenia (platelets: 120×10(9)/L). She was co-managed by a hematologist and ophthalmologists; she was treated medically. Follow-up care during the next 6 weeks revealed spontaneous, partially resolving hemorrhage, with improvement of visual acuity. The purpose of this case report is to highlight ophthalmic involvement of ITP in this patient, despite her only-mild thrombocytopenia, and her spontaneous recovery, despite her receiving only medical treatment.

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We report an atypical presentation of Antiphospholipid syndrome (APS) with concomitant subhyaloid hemorrhage, engorged and tortuous retinal veins, intraretinal hemorrhages, and cotton wool spots in a 38-year-old female. Medical treatment was preferred to any invasive treatment. The subhyaloid hemorrhage resolved spontaneously and the patient recovered a visual acuity of 20/20 in her right eye 3 months after the initial episode. A prompt diagnosis of this condition is fundamental to consider a systemic treatment to avoid any further thrombosis.

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PURPOSE: To report a case of subhyaloid hemorrhage which resulted from bungee jumping and to describe the clinical course. METHODS: A 21-year-old man who presented with acute diminution in vision following bungee jumping from a height of approximately 64m visited our ophthalmologic department 3 days after the jump. RESULTS: Best uncorrected visual acuity (UCVA) was right eye 1.0 and left eye F.C 10cm initially. He demonstrated a periocular contusion of about 1cm in the left lateral eyebrow. A full examination of the anterior segment was normal but his left fundus showed a subhyaloid hemorrhage of about 7 disc-diameters in size. There were surrounding superficial retinal hemorrhages and peripheral retinal edema. At 54 days follow-up, subhyaloid hemorrhage of about 5 disc-diameters in size remained and visual acuity was not improved. Trans pars plana vitrectomy was performed in his left eye and improved his vision. One month after the operation, the vision was 1.0 unaided in the left eye. The visual acuity remained as 1.0 eight months after the operation. CONCLUSIONS: It is important that the public should be educated about the potential hazard of bungee jumping and we recommend the use of safety glasses during the bungee jump.

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The ocular manifestations of leukemia include leukemic infiltration in optic nerve, retina, choroid, iris, ciliary body and anterior chamber, as well as retinal vascular change and hemorrhage due to systemic hemodynamic abnormalities.Occasionaly, subhyaloid hemorrhage involving the macula may cause acute loss of central visual acuity. We observed dense bilateral macular subhyaloid hemorrhage in 19-year-old man who had been diagnosed to have acute myeloid leukemia.Trans pars plana vitrectomy was performed in his both eyes, resulting in improvement of vision.

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