Outcomes of Nd:YAG Laser Posterior Membranotomy in the Treatment of Macular Preretinal Hemorrhage: A Systematic Review and Meta-Analysis

Abstract

Purpose: To examine the success rate of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior membranotomy as a treatment option to facilitate drainage of macular preretinal hemorrhage into the vitreous cavity. Methods: A literature search was conducted using the PubMed, Embase, and Scopus databases for studies describing the use of Nd:YAG laser for a posterior membranotomy in the setting of macular preretinal hemorrhages. The main outcome of interest was drainage of the hemorrhage into the vitreous cavity without need for subsequent vitrectomy. A meta-analysis of proportions measured the pooled success rate of the procedure due to any etiology. Additional meta-analyses evaluated success rates of the procedure for Valsalva retinopathy and proliferative diabetic retinopathy (PDR). Secondary outcomes of interest included complications and reasons for failure. Results: Twenty-three studies with 291 eyes were included. The pooled success rate of Nd:YAG laser posterior membranotomy was 93.7% (95% CI, 89.3%-97.3%). Additional meta-analyses identified a success rate of 97.9% (95% CI, 91.9%-100%) with Valsalva retinopathy and 90.8% (95% CI, 77.8%-99.2%) with PDR. Reasons for a failed procedure included failure of drainage secondary to a clotted hemorrhage and nonclearing vitreous hemorrhage that necessitated vitrectomy. Reported complications included 1 macular hole, 2 epiretinal membranes, 2 retinal detachments, and 3 instances of metamorphopsia. Conclusions: Nd:YAG laser posterior membranotomy is a safe treatment option for macular preretinal hemorrhages. Drainage of the hemorrhage into the vitreous facilitates absorption and can restore a patient’s vision.