http://www.evrs.eu/medias/2005/congress/Therapeutic-Approach-to-Acute-Submacular-Hemorrhage.swf

Ziya Kapran, Tugrul Altan, Mehmet Cakir, Nur Acar, Yaprak B. Ünver, Zerrin Bayrakar

Purpose:

To evaluate the efficacy of pneumatic displacement of submacular hemorrhage with sulfur hexafluoride (SF6) gas tamponade, with or without use of tissue plasminogen activator (tPA).

Methods:

Pneumatic displacement or surgical removal of the submacular hemorrhage with or without tissue plasminogen activator was done in 9 eyes of 9 patients. The etiology of the submacular hemorrhage was choroidal neovascular membrane due to age related macular degeneration in 8 eyes and idiopatic membrane in one eye. In 5 eyes 0,5 mL SF6 gas tamponade alone, in 2 eyes SF6 with 0,25 μg tPA was applied. In the remaining 2 eyes pars plana vitrectomy, drainage of subretinal hemorrhage and subretinal 25 μg tPA injection was performed.

Results:

Patients were followed-up for 4,21±4,20 (1-12) months. Mean preoperative best corrected visual acuity was 0,15±0,17 and increased to 0,23±0,27 at the end of followup. BCVA improved in 7 eyes, remained the same in 2 eyes postoperatively. Mean preoperative intraocular pressure (IOP) was 14,25±2,5mmHg, and mean postoperative IOP was 14,43±3,6mmHg. Six of 7 eyes had adequate displacement of the submacular hemorrhage in 1 week, however 1 eye underwent pars plana vitrectomy and submacular drainage of the persisting hemorrhage. One patient had intravitreal triamcinolone acetonide injection. Photodynamic therapy was performed in 2 eyes after displacement of subfoveal hemorrhage and was planned for 1 patient.

Conclusion:

In acute submacular hemorrhages, displacement or removal of the hemorrhage is necessary. This goal may be achieved either intravitreal gas injection with or without tPA, or surgery. Treatment is safe and should be preferred to observation.

Take-home message:

Treat acute submacular hemorrhage.