Aims/Purpose: submacular hemorrhage (SMH) is a well‐known cause of severe vision loss. Surgical treatment aims displacement of the blood away from the fovea to prevent macular photoreceptor damage. Different surgical techniques have been described for this purpose, but, until date, the best approach remains a matter of debate. Injection of subretinal rtPA and air was first described in 2013 reporting encouraging results. We describe our experience with this surgical technique.Methods: consecutive case series including patients with SMH managed with PPV and subretinal injection of rtPA and air. SMH was graded as small, large, extensive, or massive. SMH displacement was assessed one week after surgery.Results: 36 eyes of 36 patients were evaluated. Etiologies of SMH included age‐related macular degeneration (83.3%), macroaneurysm rupture (8.3%), ocular traumatism (5.6%) and Terson syndrome (2.8%). Average time between diagnosis and surgical intervention was 6.1 days. Hemorrhage size was classified as small in 8 patients (22.2%), large in 8 patients (22.2%), extensive in 16 patients (44.4%) and massive in 4 patients (11.1%). Sub‐RPE hemorrhage was noticed in 21 patients (58.3%). One week after surgery, SMH displacement was achieved in 33 patients (91.7%). Visual acuity improved in 28 patients (77.8%), remained stable in 4 patients (11.1%) and worsened in 4 patients (11.1%). Postoperative complications included vitreous hemorrhage (11.1%), macular hole (5.6%), and retinal detachment (5.6%).Conclusions: subretinal injection of air and rtPA is an effective technique for SMH displacement, facilitating rapid blood migration and, thus, reducing retinal deterioration and enabling greater visual recovery.References Martel JN, Mahmoud TH. Subretinal pneumatic displacement of subretinal hemorrhage. JAMA Ophthalmol. 2013; 131: 1632–5.
Read full abstract