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Two Different Options in the Treatment of Premacular Hemorrhage Secondary to Macroaneurysm

  SCIENTIFIC POSTER_Ines Coutinho Purpose: Premacular hemorrhage is one major cause of sudden visual loss and occurs in a variety of disorders, among others in retinal arterial macroaneurysms (RAM). Possible therapeutic options include observation, vitrectomy, intravitreal rT-PA injection or laser posterior hyaloidotomy. However, the best treatment is still controversial. We report on 2 cases with premacular haemorrhage due to RAM. The...

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Surgical Approach to Massive Subretinal Hemorrhages Secondary to Neovascular ARMD

Purpose: Different surgical management of massive subretinal hemorrhage secondary to ARMD will be defined. Methods: Pars plana vitrectomy (PPV) with 360 retinotomy and removal of subretinal hemorrhage and membrane +/- choroidal patch graft is performed to 3 cases of massive subretinal hemorrhage secondary to ARMD and the results and surgical videos will be presented. Take home message: Subretinal surgery is unavoidable in such cases to...

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PPV, Subretinal Injection of TPa and Intraocular Gas Tamponade for Thick Submacular Hemorrhage with ARMD

Advantages: To evaluate the safety and efficacy of pars plana vitrectomy, subretinal injection of tissue plasminogen activator (tPA) and intraocular gas tamponade for thick submacular hemorrhage caused by age-related macular degeneration. Methods: The authors reviewed the medical records of 16 consecutive patients who underwent pars plana vitrectomy, subretinal tPA (25ug/0.1ml) injection with 20% SF6 gas. The main outcome measures were...

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Treatment of Submacular Hemorrhages from Macular Degeneration – One More Option

http://www.evrs.eu/medias/2010/congress/Hemorrhages.flv Ivan Tanev (Sofia, Bulgaria) Advantages: Sub-macular hemorrhage (SMH) is one of the most common complications of the neovascular age related macular degeneration (AMD). Eyes with large sub-retinal hemorrhages arising from exudative macular degeneration have a poor prognosis due to progressive fibrosis and organization of the sub-retinal clot.  Early removal of the sub-retinal blood...

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Intravitreal Injection of Tissue Plasminogen Activator (TPA) and Gas C3F8 for the Management of Large Submacular Hemorrhage

Evangelia Papavasileiou, S. Liazos, Timothy Jackson (London, UK) Advantages: To describe the safety and efficacy of intravitreal TPA and C3F8 for the management of extensive sub macular hemorrhages (SMH), associated with AMD related choroidal neovascularisation (CNV) or Idiopathic Polypoidal Choroidal Vasculopathy (IPCV). Methods: Consecutive case series of 7 patients, presenting with acute SMH from neovascular AMD (N = 5) and IPCV (N =...

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Risk Factors for Recurrent Submacular Hemorrhage in Neovascular, Age-Related Macular Degeneration

June-Gone Kim, Sung Jae Yang, Jong Uk Hwang, Soo Geun Joe, Joo Yong Lee (Seoul, South Korea) Advantages: To describe the clinical characteristics and risk factors of recurrent, submacular hemorrhage in AMD. Methods: We reviewed the medical records of the neovascular AMD patients showing submacular hemorrhage at their onset. The required minimum follow-up period was 24 months, and any newly developed, submacular hemorrhage larger than one...

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PPV in Acute Submacular Hemorrhage (Case Report)

Authors: Lidmila Prochazkova, Martina Zavorkova, Martin Hovorka, Usti Nad Labem, Czech Republic Advantages: To diminish the central scotoma and to improve the visual acuity. Methods: Two days after an acute subretinal hemorrhage, PPV with retinotomy, drainage and SF6 tamponade was performed. Effectiveness / Safety: Subjectively significant diminishing of the central scotoma and improving of the visual acuity from 2/50 to 5/50 was reached....

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Temporal Peripheral Retinotomy for Evacuation of Submacular Hemorrhage Secondary to Arterial Macroaneurysm

http://www.evrs.eu/medias/2009/congress/Hemorrhages.flv Author: Hassan Mortada, Cairo, Egypt Advantages: Evacuation of submacular hemorrhage, secondary to arterial macroaneurysm, through a peripheral temporal retinotomy ensure rapid and complete removal of the submacular hemorrhage. This helps to prevent the toxic effect of the blood on photoreceptors with subsequent preservation of visual acuity. Experience from full macular translocation...

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Surgical Displacement of Medium-Sized Submacular Hemorrhage

http://www.evrs.eu/medias/2009/congress/Hemorrhages.flv Author: Sophie J. Bakri, Rochester, MN, USA Advantages: Surgical displacement of medium-sized thick submacular hemorrhage has the advantage of minimizing the toxic effects of blood on the retina. Methods: Pars plana vitrectomy, subretinal tPA and air-fluid exchange is performed. The patient lies flat on his back for 30 minutes, then upright for the next 24 hours. Effectiveness /...

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Submacular Hemorrhage: a Lost Eye?

http://www.evrs.eu/medias/2009/congress/Hemorrhages.flv Authors: Rossi Pietro, Claudia Castiglioni, Carlandrea Trillo, Genoa, Italy Submacular bleeding represents one of the worse end points in the evolution of age related degeneration. The aim of this investigation was to evaluate if displacement of the blood associated with anti-VEGF therapy or a RPE-choroid patch could yield a better functional outcome. Material and methods: 19 eyes of...

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Surgical Treatment of Submacular Hemorrhage

http://www.evrs.eu/medias/2009/congress/Hemorrhages.flv Authors: Grazia Pertile, Barbara Parolini, Verona, Italy Advantages: The treatment of submacular hemorrhage may benefit from different treatments on the bases of the hemorrhage’s area and location. Methods: Submacular hemorrhages located only under the retina and not under the retinal pigment epithelium (RPE) and involving an area within the arcades, were treated with intravitreal...

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An Atraumatic Method of Submacular Hemorrhage Management

http://www.evrs.eu/medias/2009/congress/Hemorrhages.flv Author: Aslanova Veronika, Odessa, Ukraine Advantages: Pneumatic displacement of SMH with intravitreal perfluoropropane without tPA allows clearing of the macular area from subretinal blood and achieves visual recovery in the short term. The procedure is atraumatic and cost-effective. Methods: Retrospective, noncomparative, interventional case series. The results of submacular...

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Pneumatic Displacement of Acute Submacular Haemorrhage with and without the Use of Tissue Plasminogen Activator

Osman Cekic, Mehmet Cakir, Omer F. Yilmaz Advantages: To displace massive submacular haemorrhage by injecting intravitreal C3F8 gas with and without the use of tissue plasminogen activator (tPA). Methods: Twenty-one eyes of 21 patients with recently developed (up to 10 days) dense submacular haemorrhage underwent intravitreal injection of pure C3F8 gas (0.4-0.5ml) followed by face down positioning for pneumatic displacement. Seven of them...

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Atramatic Approach to Submacular Hemorrhage

http://www.evrs.eu/medias/2008/congress/Atramatic-Approach-to-Submacular-Hemorrhage.flv Silvia Bopp, Klaus Lucke (Augenklinik Universitaetsallee, Bremen, Germany) Advantages: To protect the fovea from severe toxic damage due to submacular hemorrhage and avoiding subretinal surgical manipulations. Methods: Indications for surgery are fresh subfoveal hemorrhages due to exudative macular degeneration (ARMD) or ruptured retinal arterial...

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Treatment of Macular Hematoma Due to Age-related Macular Degeneration by Displacement with Vitrectomy and Gas Injection

Jean-François Le Rouic, MD (Nantes, France), Frank J. Becquet, MD, PhD (Nantes, France), Pascal Peronnet, MD (Nantes, France), Caroline Pousset-Decre, MD (Nantes, France), Elisabeth Hermouet- Leclair, (Nantes, France), Philippe Gayet, (Nantes, France), Didier Ducournau, MD (Nantes, France) PURPOSE: To report the pre- and postoperative findings after displacement of recent submacular hemorrhages due to age-related macular degeneration...

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Clinical Course of Massive Submacular Hemorrhage: A Hong Kong Perspective

David TL Liu, MD (Hong Kong, Hong Kong) PURPOSE: Study over the causes of massive submacular hemorrhage in Chinese patients. METHODS: A retrospective review of the clinical course of 20 Chinese patients with submacular hemorrhage from 2000 onwards. RESULTS: AMD has accounted for 40% of cases followed by 30% of cases being PCV. CONCLUSION: PCV has probably been under-diagnosed in Chinese patients with submacular...

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Comparison of Submacular Surgery and Natural History for the Treatment of Large Submacular Hemorrhages from Macular Degeneration

http://www.evrs.eu/medias/2006/congress/Comparison-of-Submacular-Surgery-and-Natural-History-for-the-Treatment-of-Large-Submacular-Hemorrhages-from-Macular-Degeneration.swf John T. Thompson (Towson, MD), Raymond N. Sjaarda, MD (Towson, MD) PURPOSE: To evaluate the results of vitrectomy and removal of submacular hemorrhages with the neovascular membrane complex to natural history in eyes with large submacular hemorrhages. METHODS: A...

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Pneumatic Displacement of Submacular Hemorrhage – A Case Series

http://www.evrs.eu/medias/2006/congress/Pneumatic-Displacement-of-Submacular-Hemorrhage-A-Case-Series.swf Wilson Heriot, MD (Melbourne, Australia) PURPOSE: To evaluate the clinical outcome of intravitreal tissue plasminogen activator (tPA) and expansile gas injection as a minimally invasive treatment for submacular haemorrhage (SMH). METHODS: This study was a retrospective, interventional, clinical case series examining 104 eyes of 103...

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How Many Days after Onset Is It Too Late to Evacuate Submacular Hemorrhage Secondary to AMD?

http://www.evrs.eu/medias/2006/congress/How-Many-Days-after-Onset-Is-It-Too-Late-to-Evacuate-Submacular-Hemorrhage-Secondary-to-AMD.swf Keye L. Wong, MD (Sarasota, FL), Melvin C. Chen, MD (Sarasota, FL), John H. Niffenegger, MD (Sarasota, FL) PURPOSE: Animal experiments with submacular hemorrhage suggest that irreversible photoreceptor damage may occur within 48 hours. tPA-assisted pneumatic hemodisplacement is a technique which can result...

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