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Premacular subhyaloid hemorrhage (SHH) can cause sudden and profound decrease in vision because of its location. The already existing premacular bursa provides a potential anatomical space for fluid to collect. In cases of large and slowly resolving hemorrhage, prolonged exposure of the retinal layers to hemoglobin and iron can cause irreversible tissue damage and epiretinal membrane formation. Puncturing the posterior hyaloid face using Nd:YAG laser is one of the fastest and least invasive interventions available in an outpatient setting. Sometimes more than one attempt may be required to puncture the posterior hyaloid, but if drainage occurs and there is no other underlying macular pathology, visual rehabilitation is complete. We present fundus illustrative images from 4 cases of acute premacular SHH. All 4 patients underwent immediate Nd:YAG laser–assisted hyaloidotomy. Preoperative SHHs in one eye are shown in the top row; postoperative resolution, in the bottom row: (1) a 41-year-old man with preretinal hemorrhage due to ruptured retinal artery microaneurysm, with presenting visual acuity of counting fingers at 2 meters (A-B); (2) a 20-year-old male powerlifter diagnosed with Valsalva retinopathy, with presenting visual acuity of 20/200 (C-D); (3) a 33-year-old pregnant woman with hyperemesis gravidarum, with presenting visual acuity of counting fingers at 4 meters (E-F); and (4) a 41-year-old woman diagnosed with anemic retinopathy and multiple hemorrhages, with presenting visual acuity of 20/200 (G-H). Within 1 month of surgery, visual acuity improved to 20/20 in all 4 cases.
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