Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement

Intravitreal anti-vascular endothelial growth factor monotherapy for large submacular hemorrhage secondary to neovascular age-related macular degeneration

“…Even though our patients had a larger mean SMH area than did patients in any other study, the rate of vitreous hemorrhage was not much higher than those in other studies investigating anti-VEGF agents or pneumatic displacement, which were reported to be 15 to 22.2%. 9,[22][23][24] Our results reveal that the final visual outcome was significantly worse in patients with vitreous hemorrhage than in patients without vitreous hemorrhage; however, worse visual prognosis may not be related to the vitreous hemorrhage itself, but might be related to the significantly worse BCVA at baseline in patients who developed vitreous hemorrhage. Therefore, considering our result that vitreous hemorrhage was not associated with the proportion of BCVA improvement of ≥ 3 lines after treatment, anti-VEGF therapy would not be contraindicated in patients with large SMH owing to the possibility of vitreous hemorrhage development.…”

Anatomic and functional outcome of eyes with massive submacular hemorrhage secondary to retinal macroaneurysm submitted to vitrectomy

“…The use of rtPA to assist the mechanical displacement of submacular hemorrhage appears to be an effective adjuvant technique, since it promotes lysis of fibrin and liquefies the clot, facilitating pneumatic displacement of THE blood (22)(23) . Hassan et al investigated the efficacy and safety of treating thick SMH with intravitreous rtPA and pneumatic displacement (24) . Hemorrhages were secondary to age-related macular degeneration in 13 eyes and macroaneurysm and trauma in 1 eye each.…”

“…These maneuvers may increase the risk of damage to the underlying RPE as well as to the photoreceptors and may be related to poor visual outcomes once the RPE cells and photoreceptors tend to be removed along with the clot due to their tight adherence to the hemorrhagic clot. Thereafter, large areas of RPE atrophy and retinal detachments resulting from the large retinotomy may occur in these cases (20,24,27) . The four eyes cases reported in the present study had very poor visual acuity and massive SMH at presentation and showed great visual improvement after surgery.…”

Tratamiento de una hemorragia subretiniana con r-TPA, SF6 y ranibizumab

“…Los abordajes con cirugía intraocular no han demostrado ser superiores a los tratamientos menos invasivos, y en todas las técnicas el pronóstico visual a largo plazo es reservado 4 .…”