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 showed that proliferation from peripheral retinotomy just posterior to the ora is rarely associated with proliferation.

Methods:

4 eyes with submacular hemorrhage secondary to arterial macroaneurysm underwent surgical evacuation. Following phacoemulsification and implantation of PCIOL, 20-G PPV was performed. TA-assisted peeling of the posterior hyaloid and meticulous shaving of the basal vitreous gel were performed. The temporal retina was detached through subretinal infusion of BSS using 41-G cannula. 180 degree temporal retinotomy was performed, just posterior to the ora serrata, using scissors. The temporal retina was reflected and the submacular hemorrhage was removed. The retina was reattached with PFCL, endolaser was applied through 360 degrees and the eye was filled with silicone oil. The latter was removed after 3 months. The preoperative and postoperative fundus pictures and visual acuity were recorded.

Effectiveness / Safety:

Using this technique, the subretinal blood was safely removed. Improvement and stabilization of visual acuity were achieved in all cases.

Take home message:

In experienced hands, surgical evacuation of subretinal hemorrhage secondary to arterial macroaneurysm is safe and effective in achieving rapid restoration of visual function.