9.
Subhyaloidal vs Sub-ILM Hemorrhage –
Localization and Classification
Stefan Mennel (Marburg)
Hemorrhage at the macula may cause visual deterioration within seconds or minutes.
Biomicroscopy reveals a dome-shaped bleeding in the macular area, but the precise localisation
of the blood, i.e. subhyaloidal or macular, is by funduscopy mostly indistinguishable
unknown. Histologic analysis following vitrectomy show in many cases a sub-ILM location of
the hemorrhage. It seems questionable whether available diagnostic tools allow a reliable preoperative
location of the cleavage plane.
Patients with presumed subhyaloidal hemorrhage were examined by funduscopy, ultrasound
and optical coherence tomography (OCT). Additionally, literature research was performed to
find diagnostic tools to differentiate subhyaloidal and sub-ILM hemorrhage.
Our preliminary results show that only in selected cases funduscopy, ultrasound and OCT allow to elucidate the location of
the hemorrhage. These examinations seem to be more reliable if the posterior hyaloid is already detached. After performing
laser puncture, OCT presents as an optimal method to differentiate subhyaloid and sub-ILM hemorrhage.
The absence of a definitive biomicroscopic characteristic to clinically distinguish between subhyaloidal and macular hemorrhage,
which may be important for therapeutical decisions in the future, emphasizes the need to develop additional diagnostic
techniques.