Premacular Hemorrhage

Premacular hemorrhage (PMH) is defined as blood located between the posterior hyaloid and the retina or between the internal limiting membrane and the neurosensory retina (Mennel, Br J Ophthalmol 91:850–852, 2007; Michels, Retina 1:1–17, 1981). It may exist in both spaces. Diseases commonly associated with premacular hemorrhage include but are not limited to arterial macroaneurysms, branch retinal vein occlusion (BRVO), Terson syndrome, child abuse, ocular trauma, and Valsalva maculopathy (Russell and Hageman, Retina 12:346–50, 1992). Proliferative diabetic retinopathy (PDR) is another entity that may be complicated by premacular hemorrhage (Michels, Retina 1:1–17, 1981). As neo-vessels (NVs) usually grow along the posterior hyaloid, PMHs are almost always distributed between the posterior hyaloid (PH) and the retina. Because this complication may greatly disturb central vision for a long period of time and may be an important stimulant of fibrovascular proliferation, intervention is usually indicated. Treatment methods ranging from tissue plasminogen activator (TPA) injection to YAG laser membranotomy to vitrectomy have been suggested (Chung, Ophthalmic Surg Lasers 32:7–12, 2001; Raymond, Ophthalmology 102:406–11, 1995; O’Hanley and Canny, Ophthalmology 92:507–11, 1985); however, the best treatment method has not been established. The clinical features and treatment methods used are discussed in this chapter.