Título

Preretinal hemorrhage after abdominal surgery treated with YAG-laser

Introdução / Purpose

Retinal hemorrhages can be classified according to their level in relation of retina: preretinal, intraretinal and subretinal. Certain diseases can manifest with hemorrhages in the three levels, as Valsalva retinopathy, macroaneurysm, vascular tumors, hematological disorders1,2,3,4.
Besides its low toxicity to retina, the preretinal hemorrhage can hide a subretinal hemorrhage which is even more toxic than the previous one and would require rapid vitrectomy and tissue plaminogen activator (tPA) injection1,2,3,4.
Therefore, the early treatment of preretinal hemorrhage can be useful for the early diagnosis and treatment of a possible subretinal hemorrhage1,2,3,4.The treatment of preretinal hemorrhage can be done by vitrectomy or, in a less invasive way, by YAG-laser posterior hyaloidotomy1,2,3,4.

Material e Método / Methods

No aplly

Resultados / Results

No aplly

Discussão e Conclusões / Discussion

Fundoscopic findings in this patient showed an hemorrhagic retinopathy similar to Valsalva retinopathy. However, it occurred spontaneously and there was no history of physical effort. In one of the stages of the abdominoplasty, the patient must be in prone position, wich could lead the increasing of the intra abdominal pressure and subsequent increase of venous return. We believe that the pre retinal hemorrhage was due to the rupture of pre retinal capillary secondary to the increasing of the venous pressure1,2,5,6.
In view of the macular location and extension of pre retinal hemorrhage, it was opted for early YAG-laser membranotomy, which is a less invasive procedure than vitrectomy1,2,3,4. This procedure was effective to drain almost all preretinal blood, similar to other reported cases in literature1,2,3,4. Since it was not found macular subretinal hemorrhage, early vitrectomy with tPA injection was not necessary.

Palavras Chave

PRERETINAL, HEMORRHAGE, ABDOMINAL SURGERY, YAG LASER, ABDOMINOSPLATY, TUMMY TUCK