Infusion-Assisted Evacuation of Submacular Hemorrhage.

Abstract

To report a novel surgical technique for evacuating submacular hemorrhage using the infusion stream of a 25 gauge vitrectomy system. Surgical case and video. A 54 year old male was taken to the operating room for a total hyphema, non-clearing vitreous hemorrhage, and elevated intraocular pressure after multiple tractional retinal detachment repairs by an outside surgeon. Intraoperatively the hyphema and vitreous hemorrhage were cleared, and the source of bleeding was discovered to be an avulsed vessel through a pre-existing retinal break just superior to the optic nerve. A large submacular hemorrhage was also present that was unable to be drained through the break by aspiration alone. With the vitreous cavity under fluid, the infusion cannula was manipulated to guide the infusion stream onto the macula. The stream was directed in a distal to proximal manner towards the retinal break, and the submacular blood was successfully expressed out through the break. Postoperatively the retina remained attached with almost complete resolution of the submacular hemorrhage. Utilizing the mechanical pressure of the infusion stream can be an effective method for evacuating large subretinal hemorrhages.