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Sub Inner Limiting Membrane Hemorrhage: Causes and Treatment with Vitrectomy
  1. Karolien De Maeyer (karoliendemaeyer{at}hotmail.com),
  2. Rita Van Ginderdeuren (rita.vanginderdeuren{at}uz.kuleuven.ac.be),
  3. Laurence Postelmans (laurence.postelmans{at}chu-brugmann.be),
  4. Peter Stalmans (peter.stalmans{at}uz.kuleuven.ac.be),
  5. Joachim Van Calster (joachim.vancalster{at}uz.kuleuven.ac.be)
  1. University Hospitals Leuven, Belgium
  2. University Hospitals Leuven, Belgium
  3. Chu Brugmann and Saint-Pierre Brussels, Belgium
  4. University Hospitals Leuven, Belgium
  5. University Hospitals Leuven, Belgium

    Abstract

    Background: Preretinal hemorrhages usually occur at the interface between the posterior hyaloid and inner limiting membrane (ILM). Less frequently, they are located between the ILM and the retinal nerve fiber layer. Sub-ILM hemorrhages have been described in a variety of clinical settings and often lead to severe visual impairment due to their predilection for the macular region.

    Methods: A consecutive series of five cases in which sub-ILM hemorrhages were clinically suspected and confirmed during early vitrectomy with ILM-peeling.

    Results: Sub-ILM hemorrhages were clinically suspected in five patients (median age: 32 years) based on the fundoscopic appearance and clinical setting of Terson syndrome (n=1), Valsalva retinopathy (n=2), blood dyscrasia (n=1) and blunt facial trauma (n=1). Vision was severely impaired in all patients (to hand movements in 4 of 5) due to a premacular location of the hemorrhage. All patients were treated with early pars plana vitrectomy because of insufficient spontaneous visual recovery after a median of 6 weeks. The sub-ILM location of the hemorrhage could be confirmed intra-operatively in all patients by bio-staining of the membrane overlying the hemorrhage. ILM-peeling and aspiration of the hemorrhage resulted in excellent visual recovery in all patients. There were no procedure-related complications.

    Conclusions: Sub-ILM hemorrhages often occur in a specific clinical context and can lead to severe visual impairment in young patients. Given the excellent results and low complication rates, timely surgical intervention is justified when spontaneous resorption is insufficient.

    • Inner Limiting Membrane
    • Intraretinal Hemorrhage
    • Vitrectomy

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