Pneumatic Displacement of Limited Traumatic Submacular Hemorrhage Without Tissue Plasminogen Activator: A Case Series

Poornachandra, B; Kadri, Venkatesh; Braganza, Sherine; Jayadev, Chaitra; Mehta, Ruchir; Nakhate, Vikram; Yadav, Naresh Kumar; Shetty, Rohit

doi:10.1097/icb.0000000000000525

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…The functional outcome may also be influenced by the duration and the size of submacular hemorrhage. Persistent SRMH damages the photoreceptors through three main mechanisms: iron-related toxicity, impairment of diffusion of oxygen and nutrition, and mechanical damage due to clot contraction [ 23 , 24 , 25 , 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Intravitreal r-tPA Injection and Pneumatic Displacement for Submacular Retinal Hemorrhage: A Case Series

Stene-Johansen

Lumi

et al. 2022

Case Rep Ophthalmol

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Section: Discussionmentioning

confidence: 99%

Intravitreal r-tPA Injection and Pneumatic Displacement for Submacular Retinal Hemorrhage: A Case Series

Stene-Johansen

Lumi

et al. 2022

Case Rep Ophthalmol

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“…However, this technique has become less common because it is associated with poor postoperative visual acuity and a high rate of retinal detachment [ 6 ]. Balughatta et al [ 5 ] recently reported a case series of C 3 F 8 pneumatic displacement of limited traumatic SMH with excellent anatomical results and final visual acuities attributed only to gas injection and patient positioning, without surgery or the use of tPA.…”

Section: Discussionmentioning

confidence: 99%

“…Blunt ocular trauma with SMH is a major cause of severe vision loss [ 4 ], usually affecting young patients and causing several pathological conditions such as commotion retinae, choroidal rupture, macular hole, subretinal and macular hemorrhage, retinal vascular rupture, vitreous hemorrhage, retinal pigment epithelial edema and healed scarring, retinal dialysis, macular infarction, traumatic optic neuropathy, optic nerve avulsion [ 2 ], and even retinal tears. Clinical and histopathological studies have shown that prolonged contact of the blood catabolic products with photoreceptors in the subretinal space worsens the prognostic and visual outcomes [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Multimodal Analysis in Successful Gas Displacement of a Submacular Hemorrhage

Urrea-Victoria¹,

Fulda-Graue²,

Esparza-Correa³

et al. 2021

Case Reports in Ophthalmological Medicine

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In this report, we describe a case of timely gas vitrectomy to displace a moderate submacular hemorrhage from the submacular space without tPA, release vitreoretinal traction along the borders of a posterior retinal tear, and analyze postoperative multimodal imaging findings in a 34-year-old male patient whose right eye was injured by a stone. The patient underwent a successful nontissue plasminogen activator gas vitrectomy 3 days after the accident. A multimodal evaluation with spectral-domain optical coherence tomography (SD-OCT), 10-2 and 30-2 campimetry, microperimetry, multifocal electroretinography (mfERG), and visual evoked potentials was performed 6 months after the accident. The multimodal imaging tests yielded abnormal foveal SD-OCT patterns, with a fibrous sealed tear in the retinal pigment epithelium. Campimetry showed low levels of retinal sensitivity; microperimetry and mfERG revealed a subnormal retinal response and a reduction in the N1 and P1 wave amplitudes. The visual evoked potential responses were normal. Multidisciplinary examination at 6 months postoperatively revealed a structurally and functionally abnormal macula. The retina remained attached. Our functional findings indicate that submacular hemorrhage should be treated in a timely manner to minimize photoreceptor damage.

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“…In a case series of 3 patients with post-traumatic SMH, Balughatta et al [22] used 0.3 ml of intravitreal pure C3F8, obtaining significant displacement of the SMH and visual recovery in 2 of the 3 cases.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Traumatic submacular hemorrhage: available treatment options and synthesis of the literature

et al. 2019

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Sub-macular hemorrhage (SMH) is a hematic collection between the neurosensory retina and the retinal pigment epithelium; one of its causes is ocular blunt trauma, that usually affects young patients. Persisting SMH leads to a damage of photoreceptors mediated by three main mechanisms: iron-related toxicity, impairment of diffusion of oxygen and nutriment, mechanical damage due to clot contraction. Since early photoreceptors’ damage has been reported within 24 h, it is suggested to provide an early treatment, although there are no guidelines or consensus between authors regarding treatment strategies. The aim of this review was to present and compare available treatment options, like intravitreal tissue plasminogen activator (tPA) associated with pneumatic displacement, pneumatic displacement alone, subretinal tPA injection with pneumatic displacement, and intravitreal anti-vascular endothelial growth factor (VEGF) injection. All procedures obtained consistent results, though the most effective seemed to be pars plana vitrectomy, subretinal tPA and gas tamponade, probably due to a quicker liquefaction and displacement of the clot. Limitations concern the greater invasiveness and the higher incidence of complications. Alternatively, intravitreal injection of tPA and gas may represent a less invasive option with fewer complications. Intravitreal injection of gas and prone position could be preferred in young patients without coexisting ocular pathology, being a minimally invasive treatment, with lower risk of complications and a good visual recovery. Anti-VEGF agent have found, to date, limited employment in cases of traumatic SMH even though they may be useful as alternative or adjuvant therapy. Most of the published literature consists of small studies and case reports, therefore further investigations and larger clinical trials are required to fully understand safety and efficacy of the procedures. A preoperative comprehensive evaluation may be helpful to realize a surgical plan tailored on patient.

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Pneumatic Displacement of Limited Traumatic Submacular Hemorrhage Without Tissue Plasminogen Activator: A Case Series

Abstract: Pneumatic displacement is an effective technique in the management of SMH due to recent or old blunt trauma.

Cited by 5 publications

References 15 publications

Intravitreal r-tPA Injection and Pneumatic Displacement for Submacular Retinal Hemorrhage: A Case Series

Intravitreal r-tPA Injection and Pneumatic Displacement for Submacular Retinal Hemorrhage: A Case Series

Postoperative Multimodal Analysis in Successful Gas Displacement of a Submacular Hemorrhage

Traumatic submacular hemorrhage: available treatment options and synthesis of the literature

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