Fundus photograph (a) of the left eye in a 41-year-old man with Valsalva retinopathy showing a massive premacular hemorrhage. Corresponding SD-OCT reveals a dome-shaped hypo-reflective area consistent with blood (b). Above the level of settled blood there are two distinct membranes (c): the low reflective band of the posterior hyaloid surface (red arrow) and the hyper-reflective internal limiting membrane (ILM, white arrow). Fundus photography 1 month after laser (d) shows complete resolution of the hemorrhage. Corresponding SD-OCT shows the laser perforation in the ILM (e, blue arrow) and a sub-ILM hypo-reflective space (f). Fundus photography at 3 months (g) and 8 months (j) after the Nd:YAG laser membranotomy show progressive ILM wrinkling and striae radiating from the central perforation. Based on the OCT tracking system, the un-sealed ILM defect (blue arrow) is seen to persist at 3 months (h) and 8 months (k) after treatment; and the sub-ILM space also fails to show any substantial reduction in size at the 3-month (i) or 8-month (l) follow-up.