Gravitational displacement of submacular haemorrhage in patients with age-related macular disease.

Abstract

To investigate the efficacy of gravitational displacement following vitrectomy for the patients with submacular haemorrhage (SMH) secondary to age-related macular degeneration (AMD). Retrospective, interventional series of nine consecutive AMD patients with SMH. All patients underwent pars plana vitrectomy (PPV) combined with subretinal tissue plasminogen activator (t-PA) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection without any tamponade. The patients were positioned according to the location and distribution of SMH postoperatively in order to provide the maximum gravitational force effect to displace. Outcome measures were the change in visual acuity, the displacement in SMH, and the occurrence of per- and postoperative complications. Complete displacement of haemorrhage occurred in all patients postoperatively. The mean preoperative and postoperative best-corrected visual acuity (BCVA) at the last visit were 2.46 and 1.7 logMAR, respectively, after a mean follow-up of 10.4 months (Range: 3-18 months) (p = 0.045). The mean duration of haemorrhage was 15.3 days (range: 3-40 days). The recurrence of SMH was observed in two (22%) patients and there were no other postoperative complications. Gravitational displacement following PPV combined with subretinal t-PA and intravitreal anti-VEGF injection can be considered as an effective surgical intervention in selected AMD patients with SMH.