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Malvika Singh, Akansha Sharma, Anand Gandhi, Shraddha Raj Shrivastava and Manish Nagpal
This 28YO female presented with sudden vision loss in her left eye 2 days earlier following sneezing from an upper respiratory infection. Vision was counting fingers OD and 20/20 in her normal OS.
Fundus imaging shows a large sub-internal limiting membrane (ILM) hemorrhage layered in the left macula. A rim of nerve fiber layer blood encircles the large ILM detachment. On OCT, the sub-ILM blood is markedly hyperreflective with posterior shadowing.
Our patient elected for early vitrectomy. Two weeks postoperatively, vision improved to 20/20.
Learning Points:
Valsalva hemorrhages usually develop in the macular sub-ILM space. These hemorrhages virtually always resolve without sequelae, although in severe cases the sub-ILM blood can be drained into the inferior vitreous by creating a small ILM opening with a thermal or Nd:YAG laser.
Acta Ophthalmol. 2026 Nov;104(7):731-741. doi: 10.1111/aos.70127.
PPV RRD 360-degree (vs focal laser) higher single-surgery success but similar VA. Need well-designed RCTs to confirm the magnitude of benefit — Systematic review and Meta-analysis.
Purpose: To compare the anatomic, functional and safety outcomes of intra-operative 360-degree prophylactic laser retinopexy versus focal laser retinopexy during pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) and to assess the certainty of evidence.
Methods: PubMed, Web of Science and Scopus were searched on June 27, 2025. Randomized controlled trials and comparative observational studies evaluating 360-degree versus focal laser during PPV for RRD were included. Two reviewers independently extracted data and assessed risk of bias (ROB-2, NIH tools). Pooled analyses were conducted using random-effects models, and the certainty of evidence was graded using GRADE. The primary outcome was single-surgery anatomic success (SSAS). Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP) and post-operative complications.
Results: Thirteen studies comprising 3639 eyes were included. Compared with focal laser, 360-degree laser achieved higher odds of SSAS (OR: 1.82; 95% CI, 1.40-2.39; I2 = 0%; moderate-certainty). No differences were observed in final BCVA (MD = 0.06; 95% CI, -0.01 to 0.13; I2 = 75.5%) or BCVA improvement (MD: -0.06; 95% CI, -0.22 to 0.11; I2 = 0%). Rates of epiretinal membrane (OR = 1.11; 95% CI: 0.80-1.54, I2 = 26.85%, moderate certainty), proliferative vitreoretinopathy (OR = 0.62; 95% CI: 0.36-1.08, I2 = 0%, moderate certainty), cystoid macular oedema and macular hole were comparable between groups.
Conclusion: Adjunctive 360-degree laser retinopexy during PPV for RRD was associated with higher SSAS without a measurable increase in post-operative complications. However, no improvement in visual acuity outcomes was observed. Given the predominance of observational evidence, further well-designed randomized trials are warranted to clarify the magnitude of benefit.
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