Submacular Hemorrhage is one condition which acutely threatens the vision with devastating consequences. Particularly in elderly patients, who live alone and get affected mostly due to age related macular degeneration and not so infrequent submacular hemorrhage, this is a visually and psychologically debilitating. In elderly patients the cause is mostly wet ARMD (Polyp mostly). The sub macular hemorrhage can be associated with supra choroidal hemorrhage, vitreous hemorrhage and massive sub retinal hemorrhage also. In young patients, trauma can be a significant contributory factor. If it is not managed on time, the vision loss below ambulatory level is almost universal. Once the blood gets organised and photoreceptor gets affected with altered blood, the vision is unlikely to improve. It can also cause a bad fibrotic scar below the fovea thus severely decreasing the vision. There are different opinions regarding managements in different time frames of the disease. Intravitreal perfluoro propane with anti-vascular endothelium growth factor are the main stay. Then there are options of intra vitreal tissue plasminogen activator (tPA). In more severe cases, total vitrectomy with subretinal tPA and perfluoro propane tamponade and maintenance of head position required. Sub retinal anti VEGF with air also tried. Subsequent multiple intra vitreal anti VEGF injections may be required in age related macular degeneration cases. Wise and timely interventions can do wonders. The earlier the intervention, the better is the result. In this presentation we have discussed specific cases with videos which showed different ways of management starting from conservative with intravitreal gas with anti VEGF injections to vitrectomy with sub retinal tPA injection with perfluoropropane tamponade and also vitrectomy with cleaning of sub macular hemorrhage and scar with gas tamponade. The 23 gauge and 25 gauge vitrectomy and the fine needles made it easy to control the fluidics and thus the intraocular pressure controlling the hemorrhage during sub retinal procedures. It helped to decrease the residual sub retinal blood oozing after the surgery. This video showed step wise management of different situations with both pharmacological and surgical procedures and hope to contribute to better understanding of tackling of sub macular hemorrhage.


Priyamvada Birla Aravind Eye Hospital
Kolkata, India
Email: achattopadhyay2009@gmail.com
Cell Phone: +919432274599
Work Phone: +913322894343