Differences in optical coherence tomography findings in early intervention vs late intervention surgically treated submacular hemorrhages

Abstract

AbstractPurpose The purpose of this retrospective observational study is to compare Spectral‐Domain OCT findings in early‐intervention vs late‐intervention submacular hemorrages treated surgically with vitrectomy, recombinant tissue Plasminogen Activator (rtPA) subretinal injection and gas injection.Methods Retrospective analysis of pre and post operative OCT findings of 4 patients with submacular hemorrhages treated with 23G vitrectomy, rtPA subretinal injection and gas (SF6, C3F8) injection. 2 patients were treated after 6 and 10 days of diagnosis establishment and the other 2 were treated after 21 and 28 days of diagnosis establishment. Subfoveal thickness was measured in both pre and post operative exams. Analysis of the retinal structure and submacular hemorrhage characteristics were performed.Results The early intervention group presented with higher pre‐operative subfoveal thickness (716 and 973 microns compared with 405 and 554 microns). Post operative OCT showed an important decrease in subfoveal thickness in the early intervention group (716 to 260 microns and 973 to 433 microns), not seen in the late intervention group (405 to 593 and 554 to 548 microns). Images analysis shows recent submacular hemorrhages as low density, thick, homogeneous, subretinal tumefactions that do not severely distort retina internal anatomy. Older submacular hemorrhages appear as more dense, thinner, heterogeneous masses, with retinal distortion, cysts formation and separation of the inner and outer layers of the retina.Conclusion OCT is an important exam in the evaluation of submacular hemorrhage, which may differentiate recent and late hemorrhages. Early intervention is crucial for good post operative anatomical result.