Management of acute submacular haemorrhage: Royal free hospital experience

Abstract

PurposeTo evaluate visual outcomes of patients presenting with acute submacular haemorrhage (SMH) secondary to neovascular Age Related Macular Degeneration (nAMD) treated with pars plana vitrectomy (PPV), subretinal recombinant tissue plasminogen activator (rTPA) and air.MethodsRetrospective, clinical case series. 7 patients with acute SMH secondary to nAMD, underwent PPV, instillation of 50 μg/0.1 ml subretinal alteplase and air tamponade. Data was obtained from Electronic Medical Records (EDRM) of the Royal Free Hospital from October 2013 to March 2015. Patient demographics (age, gender, and laterality), duration between onset and treatment, visual acuity (VA) and any concurrent treatment were recorded.Results7 patients were included in our study with mean age ‐ 69.1 years (Range: 60–87). 3 patients had cataract. No other ocular comorbidities. Mean period between onset of symptoms to treatment was 13.7 days (Range: 1–56). At presentation, six patients had hand movement (HM) VA and one patient had counting fingers (CF) VA. At one month post‐operatively, 6 patients (85.7%) demonstrated VA improvement ≥1 line, of whom 3 (42.9%) improved by ≥2 lines. At 6 months post‐operatively however, only 3 (42.9%) patients had sustained VA improvement. Post‐operative OCT demonstrated complete displacement of SMH in 4 patients (57.1%), while 3 patients had residual submacular organised blood.ConclusionsSubretinal rTPA following vitrectomy with air tamponade may be used to dissolve submacular blood mass enabling physicians to resume NHS funded anti‐VEGF therapy. Long‐term visual outcome is often limited by underlying disease progression.