Displacement of submacular hemorrhage secondary to age-related macular degeneration with subretinal injection of air and tissue plasminogen activator

Abstract

Submacular hemorrhage (SMH) can lead to devastating visual loss in patients with age-related macular degeneration. We retrospectively evaluated the surgical outcomes of vitrectomy with subretinal injection of tissue plasminogen activator, bevacizumab, and air in 13 cases. Visual prognosis, anatomical results obtained with optical coherence tomography (OCT), and their correlations were investigated. We analyzed OCT parameters including SMH height, pigment epithelial detachment (PED) height and width, and status of ellipsoid zone (EZ) line. Complete displacement of SMH was achieved in 12 eyes. At 3 months post-surgery, best-corrected visual acuity (BCVA) and SMH height exhibited significant improvements (P < 0.01). In eyes with preoperative SMH height < 300 µm and a detectable EZ line, BCVA was significantly improved at as early as 1 month, whereas the remaining eyes exhibited visual improvements only at 3 months. Postoperative BCVA positively correlated with preoperative BCVA (r = 0.86, P < 0.005), and negatively correlated with SMH size (r = 0.69, P < 0.01) and PED height (r = 0.58, P < 0.05) and width (r = 0.67, P < 0.05). Multivariate analyses confirmed preoperative BCVA as the predominant factor associated with postoperative BCVA (β = 1.093, P < 0.05). In conclusion, significant improvements in BCVA and anatomical findings can be achieved with our reported surgical technique. Preoperative OCT findings may influence the duration required for visual improvements.

Current Management of Subretinal Hemorrhage in Neovascular Age-Related Macular Degeneration

“…Martel et al [43, 44] reported a surgical technique of adding subretinal air in addition to subretinal tPA air to facilitate displacement of SRH. With this technique, subretinal air is expected to localize at the submacular space above subretinal fluid due to its buoyancy, thus protecting the macula from being reoccupied by the original hemorrhage.…”

Therapeutic effect of subretinal injection of alteplase plus Conbercept for acute submacular hemorrhage secondary to polypoid choroidal vasculopathy

“…There are several treatment methods for SMH. Non-vitrectomy treatments, including intravitreal injection of gas, alteplase (tPA), and anti-vascular endothelial growth factor (VEGF) drugs, have some good results; however, the treatment results are not ideal when a large SMH occurs [9][10][11]. Vitrectomy combined with mechanical removal of subretinal hemorrhage and blood clots can lead to certain complications such as retinal detachment, proliferative vitreoretinopathy, mechanical retinal injury, and retinal tears, and have an impact on patient prognosis.…”